Provider Demographics
NPI:1669786091
Name:ANY PHYSICIANS REFERENCE LABORATORY LLC
Entity type:Organization
Organization Name:ANY PHYSICIANS REFERENCE LABORATORY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:MAZHAR
Authorized Official - Middle Name:
Authorized Official - Last Name:KHAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:734-421-6415
Mailing Address - Street 1:29771 GREENLAND ST
Mailing Address - Street 2:
Mailing Address - City:LIVONIA
Mailing Address - State:MI
Mailing Address - Zip Code:48154-3225
Mailing Address - Country:US
Mailing Address - Phone:734-421-6415
Mailing Address - Fax:734-421-9087
Practice Address - Street 1:24361 GREENFIELD RD
Practice Address - Street 2:STE #209-A
Practice Address - City:SOUTHFIELD
Practice Address - State:MI
Practice Address - Zip Code:48075-3139
Practice Address - Country:US
Practice Address - Phone:734-421-6415
Practice Address - Fax:734-421-9087
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-07-27
Last Update Date:2011-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI23D2009844291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory