Provider Demographics
NPI:1336464668
Name:GREAT LAKES MEDICAL LABORATORY INC
Entity Type:Organization
Organization Name:GREAT LAKES MEDICAL LABORATORY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:NABEEL
Authorized Official - Middle Name:
Authorized Official - Last Name:AHMED
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:248-254-3950
Mailing Address - Street 1:33469 W. 14 MILES RD, SUITE 120
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48331-6108
Mailing Address - Country:US
Mailing Address - Phone:248-254-3950
Mailing Address - Fax:248-957-8611
Practice Address - Street 1:33469 W. 14 MILES RD, SUITE 120
Practice Address - Street 2:
Practice Address - City:FARMINGTON HILLS
Practice Address - State:MI
Practice Address - Zip Code:48331-6108
Practice Address - Country:US
Practice Address - Phone:248-254-3950
Practice Address - Fax:248-957-8611
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-03-30
Last Update Date:2017-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory