Provider Demographics
NPI:1942825633
Name:MIDWEST INNOVATION LABORATORY LLC
Entity Type:Organization
Organization Name:MIDWEST INNOVATION LABORATORY LLC
Other - Org Name:HDL LABS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:FAREED
Authorized Official - Middle Name:
Authorized Official - Last Name:KATARIWALA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:314-408-3394
Mailing Address - Street 1:1027 DUTCH MILL DR
Mailing Address - Street 2:
Mailing Address - City:BALLWIN
Mailing Address - State:MO
Mailing Address - Zip Code:63011-3678
Mailing Address - Country:US
Mailing Address - Phone:314-408-3394
Mailing Address - Fax:314-778-9700
Practice Address - Street 1:11475 OLDE CABIN RD STE 150
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63141-7129
Practice Address - Country:US
Practice Address - Phone:314-408-3394
Practice Address - Fax:314-942-6800
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-06-09
Last Update Date:2022-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory