Provider Demographics
NPI:1043048911
Name:METABOLIC MEDICINE LAB PLLC
Entity type:Organization
Organization Name:METABOLIC MEDICINE LAB PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SEAN
Authorized Official - Middle Name:
Authorized Official - Last Name:CASSLEMAN
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:313-598-0799
Mailing Address - Street 1:1025 BISHOP RD
Mailing Address - Street 2:
Mailing Address - City:GROSSE POINTE PARK
Mailing Address - State:MI
Mailing Address - Zip Code:48230-1447
Mailing Address - Country:US
Mailing Address - Phone:313-598-0799
Mailing Address - Fax:
Practice Address - Street 1:21444 HARPER AVE
Practice Address - Street 2:
Practice Address - City:SAINT CLAIR SHORES
Practice Address - State:MI
Practice Address - Zip Code:48080-2244
Practice Address - Country:US
Practice Address - Phone:586-275-7796
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-07-23
Last Update Date:2024-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty