Provider Demographics
NPI:1881259760
Name:MICROIT DIAGNOSTICS INC
Entity type:Organization
Organization Name:MICROIT DIAGNOSTICS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:BERTRAND
Authorized Official - Middle Name:
Authorized Official - Last Name:TANKOUO SANDJONG
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:831-235-8266
Mailing Address - Street 1:5117 34TH ST STE B
Mailing Address - Street 2:
Mailing Address - City:LUBBOCK
Mailing Address - State:TX
Mailing Address - Zip Code:79410-2304
Mailing Address - Country:US
Mailing Address - Phone:831-235-8266
Mailing Address - Fax:806-993-2000
Practice Address - Street 1:5117 34TH ST STE B
Practice Address - Street 2:
Practice Address - City:LUBBOCK
Practice Address - State:TX
Practice Address - Zip Code:79410-2304
Practice Address - Country:US
Practice Address - Phone:831-235-8266
Practice Address - Fax:806-993-2000
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-05-06
Last Update Date:2019-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory