Provider Demographics
NPI:1801182522
Name:LIFE-LINE DIAGNOSTICS, INC.
Entity Type:Organization
Organization Name:LIFE-LINE DIAGNOSTICS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:ARSHAD
Authorized Official - Middle Name:
Authorized Official - Last Name:ALI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:313-581-6641
Mailing Address - Street 1:13530 MICHIGAN AVE
Mailing Address - Street 2:SUITE 302
Mailing Address - City:DEARBORN
Mailing Address - State:MI
Mailing Address - Zip Code:48126-3574
Mailing Address - Country:US
Mailing Address - Phone:313-581-6641
Mailing Address - Fax:313-581-6648
Practice Address - Street 1:13530 MICHIGAN AVE
Practice Address - Street 2:SUITE 302
Practice Address - City:DEARBORN
Practice Address - State:MI
Practice Address - Zip Code:48126-3574
Practice Address - Country:US
Practice Address - Phone:313-581-6641
Practice Address - Fax:313-581-6648
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-06-21
Last Update Date:2011-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0208XAmbulatory Health Care FacilitiesClinic/CenterRadiology, Mobile