Provider Demographics
NPI:1629472808
Name:THERAMEDICAL LABORATORIES, LLC
Entity Type:Organization
Organization Name:THERAMEDICAL LABORATORIES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:MATT
Authorized Official - Middle Name:
Authorized Official - Last Name:MALUCHNIK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:419-509-1635
Mailing Address - Street 1:PO BOX 12
Mailing Address - Street 2:
Mailing Address - City:PERRYSBURG
Mailing Address - State:OH
Mailing Address - Zip Code:43552-0012
Mailing Address - Country:US
Mailing Address - Phone:419-509-1635
Mailing Address - Fax:877-765-5868
Practice Address - Street 1:24555 SOUTHFIELD RD
Practice Address - Street 2:SUITE 120
Practice Address - City:SOUTHFIELD
Practice Address - State:MI
Practice Address - Zip Code:48075-2738
Practice Address - Country:US
Practice Address - Phone:419-509-1635
Practice Address - Fax:877-765-5868
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-10-16
Last Update Date:2014-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory