Provider Demographics
NPI:1568974913
Name:MIDWEST MEDICAL LAB LLC
Entity Type:Organization
Organization Name:MIDWEST MEDICAL LAB LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:FOUAD
Authorized Official - Middle Name:
Authorized Official - Last Name:BAYDOUN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:313-544-3614
Mailing Address - Street 1:1916 N REYNOLDS RD
Mailing Address - Street 2:
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43615-3510
Mailing Address - Country:US
Mailing Address - Phone:248-234-8617
Mailing Address - Fax:888-298-9165
Practice Address - Street 1:1916 N REYNOLDS RD
Practice Address - Street 2:
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43615-3510
Practice Address - Country:US
Practice Address - Phone:248-234-8617
Practice Address - Fax:888-298-9165
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-10-25
Last Update Date:2017-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH=========OtherAUTO & HEALTH INSURANCE