Provider Demographics
NPI:1497906481
Name:WESTSHORE DIAGNOSTICS, PC
Entity Type:Organization
Organization Name:WESTSHORE DIAGNOSTICS, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:OCTAVIA
Authorized Official - Middle Name:B
Authorized Official - Last Name:GRAUR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:231-728-5758
Mailing Address - Street 1:3104 HENRY ST
Mailing Address - Street 2:
Mailing Address - City:NORTON SHORES
Mailing Address - State:MI
Mailing Address - Zip Code:49441-4018
Mailing Address - Country:US
Mailing Address - Phone:231-728-5758
Mailing Address - Fax:231-728-5636
Practice Address - Street 1:3104 HENRY ST
Practice Address - Street 2:
Practice Address - City:NORTON SHORES
Practice Address - State:MI
Practice Address - Zip Code:49441-4018
Practice Address - Country:US
Practice Address - Phone:231-728-5758
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-08
Last Update Date:2021-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory