Provider Demographics
NPI:1285037945
Name:INTERLAB LLC
Entity Type:Organization
Organization Name:INTERLAB LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MALIK
Authorized Official - Middle Name:
Authorized Official - Last Name:KARIM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:314-960-1052
Mailing Address - Street 1:PO BOX 958514
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63195-8514
Mailing Address - Country:US
Mailing Address - Phone:636-486-0436
Mailing Address - Fax:636-486-1894
Practice Address - Street 1:2730 S SAINT PETERS PKWY
Practice Address - Street 2:SUITE 200
Practice Address - City:SAINT PETERS
Practice Address - State:MO
Practice Address - Zip Code:63303-5677
Practice Address - Country:US
Practice Address - Phone:636-486-0436
Practice Address - Fax:636-486-1894
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-10-08
Last Update Date:2014-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory