Provider Demographics
NPI:1417316100
Name:QUANTUM LABS
Entity Type:Organization
Organization Name:QUANTUM LABS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:OLUSEYI
Authorized Official - Middle Name:
Authorized Official - Last Name:AYANGADE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:248-262-7731
Mailing Address - Street 1:1175 AMERICAN PACIFIC DR STE F
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89074-8768
Mailing Address - Country:US
Mailing Address - Phone:702-637-0860
Mailing Address - Fax:702-939-9064
Practice Address - Street 1:24555 SOUTHFIELD RD STE L-70
Practice Address - Street 2:
Practice Address - City:SOUTHFIELD
Practice Address - State:MI
Practice Address - Zip Code:48075-2738
Practice Address - Country:US
Practice Address - Phone:248-262-7731
Practice Address - Fax:888-392-6043
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-02-23
Last Update Date:2016-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory