Provider Demographics
NPI:1205691920
Name:SPARTAN DIAGNOSTICS LLC
Entity type:Organization
Organization Name:SPARTAN DIAGNOSTICS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:MR
Authorized Official - First Name:DORIAN
Authorized Official - Middle Name:BLAKE-LEE
Authorized Official - Last Name:WRIGHT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:734-368-2686
Mailing Address - Street 1:1098 ANN ARBOR RD W # 545
Mailing Address - Street 2:
Mailing Address - City:PLYMOUTH
Mailing Address - State:MI
Mailing Address - Zip Code:48170-2129
Mailing Address - Country:US
Mailing Address - Phone:734-368-2686
Mailing Address - Fax:
Practice Address - Street 1:30600 TELEGRAPH RD STE 1375A
Practice Address - Street 2:
Practice Address - City:BINGHAM FARMS
Practice Address - State:MI
Practice Address - Zip Code:48025-4530
Practice Address - Country:US
Practice Address - Phone:313-900-5948
Practice Address - Fax:888-893-8920
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-02-21
Last Update Date:2024-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory