Provider Demographics
NPI:1285754515
Name:OMIC LLC
Entity type:Organization
Organization Name:OMIC LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:BUSINESS MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:ALLIE
Authorized Official - Middle Name:
Authorized Official - Last Name:GALOVICH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:248-681-8187
Mailing Address - Street 1:5119 ROCHESTER RD
Mailing Address - Street 2:
Mailing Address - City:TROY
Mailing Address - State:MI
Mailing Address - Zip Code:48085-3426
Mailing Address - Country:US
Mailing Address - Phone:248-740-0777
Mailing Address - Fax:248-740-0777
Practice Address - Street 1:5119 ROCHESTER RD
Practice Address - Street 2:
Practice Address - City:TROY
Practice Address - State:MI
Practice Address - Zip Code:48085-3426
Practice Address - Country:US
Practice Address - Phone:248-740-0777
Practice Address - Fax:248-740-0777
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-30
Last Update Date:2008-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI300F359020OtherBCBSM
MI166815OtherGLHP
MI166815OtherGLHP