Detroit Biomed Baldwin

Primary specialty

Clinical Medical LaboratoryTaxonomy code 291U00000X

License

002174 Issued in 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

Last updated

Aug 22, 2020By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Raymond P Zakaria, MS

Title

Manager

Phone

(248) 471-4111

Specialties & licenses 1

Addresses

Other identifiers 1

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Tax ID family

Detroit Bio Medical Laboratoriesinc3 organizations share this tax ID, including this one

Other organizations with this tax ID 2

Organizations that report the same tax identification number in the National Provider Directory.

• Detroit Bio Medical Laboratories,Inc

  • Clinical Medical Laboratory
  • White Cloud, MI
  • NPI 1104044957
  NPD tax ID
• Detroit Bio Medical Laboratories,Inc

  • Clinical Medical Laboratory
  • Battle Creek, MI
  • NPI 1891913646
  NPD tax ID

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1177372800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1295953040",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "23955 FREEWAY PARK DR",
            "city": "FARMINGTON HILLS",
            "state": "MI",
            "postal_code": "483352817",
            "telephone_number": "248-471-4111",
            "fax_number": "248-471-2340"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1615 MICHIGAN AVE",
            "city": "BALDWIN",
            "state": "MI",
            "postal_code": "493047984",
            "telephone_number": "231-745-8635",
            "fax_number": "248-471-4111"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DETROIT BIOMED BALDWIN",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-04-24",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "ZAKARIA",
        "authorized_official_first_name": "RAYMOND",
        "authorized_official_middle_name": "P",
        "authorized_official_title_or_position": "MANAGER",
        "authorized_official_telephone_number": "248-471-4111",
        "authorized_official_credential": "MS"
    },
    "taxonomies": [
        {
            "code": "291U00000X",
            "taxonomy_group": "",
            "desc": "Clinical Medical Laboratory",
            "state": "MI",
            "license": "002174",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "3077860",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Daniel James Bow, D.O.
• Chelsea Broersma, RN
• Cannaluv (Impaczo)
• Katrina Carrigan, OTRL
• Anna Jacqueline Cvetich
• Alissa Marie Diltz
• Divinicare LLC (Divinicare)
• Betty Jean Durden, MSW LMSW
• Family Optometric Centers PLC
• Amie Fenton

• Clinical Medical Laboratory in Baldwin, MI
• Providers in Baldwin, MI by specialty
• Clinical Medical Laboratory in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.