Provider Demographics
NPI:1376043448
Name:MEDSTAR LABORATORY LLC
Entity Type:Organization
Organization Name:MEDSTAR LABORATORY LLC
Other - Org Name:MEDSTAR LABORATORY LLC
Other - Org Type:Other Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:ARSHADULLAH
Authorized Official - Middle Name:
Authorized Official - Last Name:SYED
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:630-677-5272
Mailing Address - Street 1:2655 W GUADALUPE RD STE 31B
Mailing Address - Street 2:
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85202-7245
Mailing Address - Country:US
Mailing Address - Phone:630-677-5272
Mailing Address - Fax:480-491-5584
Practice Address - Street 1:2655 W GUADALUPE RD STE 31B
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85202-7245
Practice Address - Country:US
Practice Address - Phone:630-677-5272
Practice Address - Fax:480-491-5584
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-02-15
Last Update Date:2018-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory