Provider Demographics
NPI:1861018749
Name:FUNCTIONAL FLUIDICS INC
Entity Type:Organization
Organization Name:FUNCTIONAL FLUIDICS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:PATRICK
Authorized Official - Middle Name:
Authorized Official - Last Name:HINES
Authorized Official - Suffix:
Authorized Official - Credentials:MD PHD
Authorized Official - Phone:313-482-9435
Mailing Address - Street 1:440 BURROUGHS ST STE 641
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48202-3474
Mailing Address - Country:US
Mailing Address - Phone:313-482-9435
Mailing Address - Fax:
Practice Address - Street 1:440 BURROUGHS ST STE 641
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48202-3474
Practice Address - Country:US
Practice Address - Phone:313-482-9435
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-06-17
Last Update Date:2020-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory