Provider Demographics
NPI:1427639418
Name:CONSORTIUM LABORATORY SERVICES, LLC
Entity type:Organization
Organization Name:CONSORTIUM LABORATORY SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:ALI
Authorized Official - Middle Name:
Authorized Official - Last Name:GABALI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:734-717-2895
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:
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:586-275-2440
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-04-20
Last Update Date:2021-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory