Provider Demographics
NPI:1346611092
Name:BIOTOX LABORATORY, LLC
Entity type:Organization
Organization Name:BIOTOX LABORATORY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ANWAR
Authorized Official - Middle Name:
Authorized Official - Last Name:BAKER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:313-427-8960
Mailing Address - Street 1:4619 ALLEN RD
Mailing Address - Street 2:
Mailing Address - City:ALLEN PARK
Mailing Address - State:MI
Mailing Address - Zip Code:48101-2765
Mailing Address - Country:US
Mailing Address - Phone:313-427-8960
Mailing Address - Fax:
Practice Address - Street 1:4619 ALLEN RD
Practice Address - Street 2:
Practice Address - City:ALLEN PARK
Practice Address - State:MI
Practice Address - Zip Code:48101-2765
Practice Address - Country:US
Practice Address - Phone:313-427-8960
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:BIOTOX LABORATORY, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2015-10-07
Last Update Date:2024-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory