Provider Demographics
NPI:1568830602
Name:CORELAB DIAGNOSTICS
Entity Type:Organization
Organization Name:CORELAB DIAGNOSTICS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ZAHID
Authorized Official - Middle Name:
Authorized Official - Last Name:KALEEM
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:314-368-1540
Mailing Address - Street 1:10854 MIDWEST INDUSTRIAL BLVD
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63132-1611
Mailing Address - Country:US
Mailing Address - Phone:314-736-6709
Mailing Address - Fax:
Practice Address - Street 1:10854 MIDWEST INDUSTRIAL BLVD
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63132-1611
Practice Address - Country:US
Practice Address - Phone:314-736-6709
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-09-07
Last Update Date:2016-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO112142291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory