Provider Demographics
NPI:1871776211
Name:DMC UNIVERSITY LABORATORIES
Entity type:Organization
Organization Name:DMC UNIVERSITY LABORATORIES
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:LABORATORY DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:WAEL
Authorized Official - Middle Name:A
Authorized Official - Last Name:SAKR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:313-745-2525
Mailing Address - Street 1:4707 SAINT ANTOINE ST
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48201-1427
Mailing Address - Country:US
Mailing Address - Phone:313-745-2525
Mailing Address - Fax:313-745-9661
Practice Address - Street 1:4707 SAINT ANTOINE ST
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48201-1427
Practice Address - Country:US
Practice Address - Phone:313-745-2525
Practice Address - Fax:313-745-9661
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:DMC UNIVERSITY LABORATORIES
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-12-07
Last Update Date:2007-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI2913606Medicaid