Provider Demographics
NPI:1225383631
Name:OUTEST MEDICAL
Entity Type:Organization
Organization Name:OUTEST MEDICAL
Other - Org Name:OUTEST NEURODIAGNOSTICS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:GREGORY
Authorized Official - Middle Name:S
Authorized Official - Last Name:LUKASIK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:248-330-3520
Mailing Address - Street 1:6418 MISSION COURT
Mailing Address - Street 2:
Mailing Address - City:WEST BLOOMFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48324-1398
Mailing Address - Country:US
Mailing Address - Phone:248-330-3520
Mailing Address - Fax:
Practice Address - Street 1:2055 FRANKLIN
Practice Address - Street 2:
Practice Address - City:BLOOMFIELD TWP.,
Practice Address - State:MI
Practice Address - Zip Code:48302
Practice Address - Country:US
Practice Address - Phone:248-499-6820
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-07-23
Last Update Date:2012-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes246ZE0600XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherElectroneurodiagnosticGroup - Single Specialty