Provider Demographics
NPI:1164815924
Name:MNA LAB, LLC
Entity Type:Organization
Organization Name:MNA LAB, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:
Authorized Official - Last Name:GIANCARLO
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:586-445-9900
Mailing Address - Street 1:34025 HARPER AVE
Mailing Address - Street 2:
Mailing Address - City:CLINTON TWP
Mailing Address - State:MI
Mailing Address - Zip Code:48035-3737
Mailing Address - Country:US
Mailing Address - Phone:586-445-9900
Mailing Address - Fax:
Practice Address - Street 1:24555 SOUTHFIELD RD
Practice Address - Street 2:SUITE 190
Practice Address - City:SOUTHFIELD
Practice Address - State:MI
Practice Address - Zip Code:48075-2738
Practice Address - Country:US
Practice Address - Phone:248-234-8739
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-03-17
Last Update Date:2015-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory