Provider Demographics
NPI:1710656129
Name:MSU HEALTH LAB, LLC
Entity Type:Organization
Organization Name:MSU HEALTH LAB, LLC
Other - Org Name:MSU HEALTH CARE LABORATORIES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:JEFF
Authorized Official - Middle Name:
Authorized Official - Last Name:PANIAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:616-780-9880
Mailing Address - Street 1:6620 HIGHLAND RD STE 210
Mailing Address - Street 2:
Mailing Address - City:WATERFORD
Mailing Address - State:MI
Mailing Address - Zip Code:48327-1682
Mailing Address - Country:US
Mailing Address - Phone:888-275-5221
Mailing Address - Fax:888-275-5224
Practice Address - Street 1:6620 HIGHLAND RD STE 210
Practice Address - Street 2:
Practice Address - City:WATERFORD
Practice Address - State:MI
Practice Address - Zip Code:48327-1682
Practice Address - Country:US
Practice Address - Phone:888-275-5221
Practice Address - Fax:888-275-5224
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-09-09
Last Update Date:2024-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory