Provider Demographics
NPI:1215065883
Name:MICHIGAN DEPT OF HEALTH AND HUMAN SERVICES
Entity type:Organization
Organization Name:MICHIGAN DEPT OF HEALTH AND HUMAN SERVICES
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:LABORATORY DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:SANDIP
Authorized Official - Middle Name:
Authorized Official - Last Name:SHAH
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:517-335-8063
Mailing Address - Street 1:3350 N MARTIN LUTHER KING JR BLVD
Mailing Address - Street 2:STATE LABORATORY
Mailing Address - City:LANSING
Mailing Address - State:MI
Mailing Address - Zip Code:48906-2978
Mailing Address - Country:US
Mailing Address - Phone:517-335-8063
Mailing Address - Fax:517-335-8051
Practice Address - Street 1:3350 N MARTIN LUTHER KING JR BLVD
Practice Address - Street 2:STATE LABORATORY
Practice Address - City:LANSING
Practice Address - State:MI
Practice Address - Zip Code:48906-2978
Practice Address - Country:US
Practice Address - Phone:517-335-8063
Practice Address - Fax:517-335-8051
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-02
Last Update Date:2020-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI23D0650909291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4778402Medicaid