Provider Demographics
NPI:1871548495
Name:IN HOME DIAGNOSTICS LLC
Entity type:Organization
Organization Name:IN HOME DIAGNOSTICS LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:EVANS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:248-352-7071
Mailing Address - Street 1:3319 N. ELSTON AVE.
Mailing Address - Street 2:SUITE 116
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60618-5811
Mailing Address - Country:US
Mailing Address - Phone:248-352-7071
Mailing Address - Fax:248-485-6535
Practice Address - Street 1:24450 EVERGREEN RD
Practice Address - Street 2:SUITE 200
Practice Address - City:SOUTHFIELD
Practice Address - State:MI
Practice Address - Zip Code:48075-5518
Practice Address - Country:US
Practice Address - Phone:248-352-7071
Practice Address - Fax:248-485-6535
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-23
Last Update Date:2012-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes246XC2903XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist CardiovascularVascular SpecialistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIP00440207OtherRRMCR GROUP PIN
MI1871548495OtherNPI
MI0P45060Medicare PIN