Provider Demographics
NPI:1386395127
Name:CONSORTIUMS LABORATORY SERVICES LLC
Entity type:Organization
Organization Name:CONSORTIUMS LABORATORY SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING EMPLOYEE
Authorized Official - Prefix:
Authorized Official - First Name:AHSHAN
Authorized Official - Middle Name:
Authorized Official - Last Name:LATIF
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:313-478-4259
Mailing Address - Street 1:31201 CHICAGO RD S STE B102
Mailing Address - Street 2:
Mailing Address - City:WARREN
Mailing Address - State:MI
Mailing Address - Zip Code:48093-5500
Mailing Address - Country:US
Mailing Address - Phone:586-698-2096
Mailing Address - Fax:
Practice Address - Street 1:31201 CHICAGO RD S STE B102
Practice Address - Street 2:
Practice Address - City:WARREN
Practice Address - State:MI
Practice Address - Zip Code:48093-5500
Practice Address - Country:US
Practice Address - Phone:586-698-2096
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-01-13
Last Update Date:2022-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory