Provider Demographics
NPI:1619648664
Name:AGGRANDIZE DIAGNOSTIC TESTING
Entity Type:Organization
Organization Name:AGGRANDIZE DIAGNOSTIC TESTING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:SARITA
Authorized Official - Middle Name:
Authorized Official - Last Name:STRAIT
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:313-740-7733
Mailing Address - Street 1:20966 GRAND RIVER AVE
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48219-3937
Mailing Address - Country:US
Mailing Address - Phone:313-740-7733
Mailing Address - Fax:
Practice Address - Street 1:20966 GRAND RIVER AVE
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48219-3937
Practice Address - Country:US
Practice Address - Phone:313-740-7733
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-09-21
Last Update Date:2021-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes291U00000XLaboratoriesClinical Medical LaboratoryGroup - Multi-Specialty
No247ZC0005XTechnologists, Technicians & Other Technical Service ProvidersTechnician, PathologyClinical Laboratory Director, Non-physicianGroup - Multi-Specialty