Provider Demographics
NPI:1497714323
Name:SYA LABORATORY
Entity Type:Organization
Organization Name:SYA LABORATORY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MOHAMMAD
Authorized Official - Middle Name:TAISSIR
Authorized Official - Last Name:ALNOURI
Authorized Official - Suffix:
Authorized Official - Credentials:BS
Authorized Official - Phone:586-306-2189
Mailing Address - Street 1:5455 MAYFAIR ST
Mailing Address - Street 2:
Mailing Address - City:DEARBORN HEIGHTS
Mailing Address - State:MI
Mailing Address - Zip Code:48125-3020
Mailing Address - Country:US
Mailing Address - Phone:586-306-2189
Mailing Address - Fax:
Practice Address - Street 1:5455 MAYFAIR ST
Practice Address - Street 2:
Practice Address - City:DEARBORN HEIGHTS
Practice Address - State:MI
Practice Address - Zip Code:48125-3020
Practice Address - Country:US
Practice Address - Phone:586-306-2189
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-20
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory