Detroit Biomed Baldwin
Organization Active NPI Clinical Medical Laboratory · Baldwin, MI
NPI 1295953040 · NPPES record last updated Aug 22, 2020
Key facts
- NPI
- 1295953040
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Clinical Medical Laboratory 291U00000X
- License
- 002174 (MI)
- Legal business name
- DETROIT BIOMED BALDWIN
- Practice address
- 1615 Michigan Ave
Baldwin, MI 49304-7984 - Phone
- (231) 745-8635
- Fax
- (248) 471-4111
- NPI assigned
- Apr 24, 2007
- Organization subpart
- No
Authorized official
- Name
- Raymond P Zakaria, MS
- Title
- Manager
- Phone
- (248) 471-4111
Corporate family (same tax ID) 2
Laboratory certificates & supplier records
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 23D1064894 | Family Health Care - Baldwin | Certificate of waiver | May 17, 2028 |
National Provider Directory
- Tax ID family
- Detroit Bio Medical Laboratoriesinc
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Medical Laboratory | 291U00000X | 002174 | MI | Yes |
Addresses
Primary practice location
1615 Michigan Ave
Baldwin, MI 49304-7984
Mailing address
23955 Freeway Park Dr
Farmington Hills, MI 48335-2817
Phone (248) 471-4111
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 3077860 | Medicaid | MI |
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- Alissa Marie Diltz
- Divinicare LLC
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All providers in Baldwin, MI · Clinical Medical Laboratory in Michigan
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Aug 22, 2020. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.