Provider Demographics
NPI:1700247947
Name:KLARITY MEDICAL LABORATORY
Entity Type:Organization
Organization Name:KLARITY MEDICAL LABORATORY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER / PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:MARTIAL
Authorized Official - Middle Name:
Authorized Official - Last Name:KNIESER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:317-288-5187
Mailing Address - Street 1:7430 N SHADELAND AVE
Mailing Address - Street 2:SUITE 150
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46250-2070
Mailing Address - Country:US
Mailing Address - Phone:317-288-5187
Mailing Address - Fax:317-288-5311
Practice Address - Street 1:7430 N SHADELAND AVE
Practice Address - Street 2:SUITE 150
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46250-2070
Practice Address - Country:US
Practice Address - Phone:317-288-5187
Practice Address - Fax:317-288-5311
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-03-16
Last Update Date:2016-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical PathologyGroup - Single Specialty