Provider Demographics
NPI:1578968459
Name:TRICITY LABORATORY, LLC
Entity Type:Organization
Organization Name:TRICITY LABORATORY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:WAQAR
Authorized Official - Middle Name:Q
Authorized Official - Last Name:MIAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:989-780-4415
Mailing Address - Street 1:3265 N CHURCHHILL LANE
Mailing Address - Street 2:UNIT 4
Mailing Address - City:SAGINAW
Mailing Address - State:MI
Mailing Address - Zip Code:48603
Mailing Address - Country:US
Mailing Address - Phone:989-780-4415
Mailing Address - Fax:
Practice Address - Street 1:24555 SOUTHFIELD RD
Practice Address - Street 2:SUITE 150
Practice Address - City:SOUTHFIELD
Practice Address - State:MI
Practice Address - Zip Code:48075-2738
Practice Address - Country:US
Practice Address - Phone:989-780-4415
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-11-04
Last Update Date:2014-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory