Provider Demographics
NPI:1497000509
Name:AZRA LABS, INC.
Entity Type:Organization
Organization Name:AZRA LABS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:ASHER
Authorized Official - Middle Name:JAVAID
Authorized Official - Last Name:BASHIR
Authorized Official - Suffix:
Authorized Official - Credentials:JD
Authorized Official - Phone:517-206-1388
Mailing Address - Street 1:2843 E GRAND RIVER AVE
Mailing Address - Street 2:BOX 260
Mailing Address - City:EAST LANSING
Mailing Address - State:MI
Mailing Address - Zip Code:48823-6722
Mailing Address - Country:US
Mailing Address - Phone:517-206-1388
Mailing Address - Fax:
Practice Address - Street 1:4136 LEGACY PKWY
Practice Address - Street 2:SUITE 110
Practice Address - City:LANSING
Practice Address - State:MI
Practice Address - Zip Code:48911-4265
Practice Address - Country:US
Practice Address - Phone:517-206-1388
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-07-16
Last Update Date:2012-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QS1200XAmbulatory Health Care FacilitiesClinic/CenterSleep Disorder Diagnostic
No291U00000XLaboratoriesClinical Medical Laboratory
No335V00000XSuppliersPortable X-ray and/or Other Portable Diagnostic Imaging Supplier