Provider Demographics
NPI:1013442573
Name:CM LAB INC.
Entity Type:Organization
Organization Name:CM LAB INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:F
Authorized Official - Last Name:BOGDAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:954-552-1003
Mailing Address - Street 1:20861 JOHNSON ST STE 117
Mailing Address - Street 2:
Mailing Address - City:PEMBROKE PINES
Mailing Address - State:FL
Mailing Address - Zip Code:33029-1927
Mailing Address - Country:US
Mailing Address - Phone:954-704-9116
Mailing Address - Fax:
Practice Address - Street 1:20861 JOHNSON ST STE 117
Practice Address - Street 2:
Practice Address - City:PEMBROKE PINES
Practice Address - State:FL
Practice Address - Zip Code:33029-1927
Practice Address - Country:US
Practice Address - Phone:954-704-9116
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-04-21
Last Update Date:2017-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL10D1046281291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory