Provider Demographics
NPI:1528394889
Name:MAJESTY DIAGNOSTIC COMPANY
Entity Type:Organization
Organization Name:MAJESTY DIAGNOSTIC COMPANY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:BASAM
Authorized Official - Middle Name:
Authorized Official - Last Name:SHAMOUN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:586-713-8397
Mailing Address - Street 1:4460 15 MILE RD
Mailing Address - Street 2:
Mailing Address - City:STERLING HEIGHTS
Mailing Address - State:MI
Mailing Address - Zip Code:48310-5586
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:4460 15 MILE RD
Practice Address - Street 2:
Practice Address - City:STERLING HEIGHTS
Practice Address - State:MI
Practice Address - Zip Code:48310-5586
Practice Address - Country:US
Practice Address - Phone:586-713-8397
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-10-21
Last Update Date:2009-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center