Organization
MEDICAL DIAGNOSTIC LAB, INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
PETER J KALABAT M.D. (MEDICAL DIRECTOR)
(248) 649-8700
Entity
Organization
Contact information
Practice address
1551 W BIG BEAVER RD, D15, TROY, MI 48084-3528
(248) 659-8700
Mailing address
1551 W BIG BEAVER RD STE D15, TROY, MI 48084-3528
(248) 659-8700
Taxonomy
Speciality
Code
Description
License number
State
207ZP0102X
Anatomic Pathology & Clinical Pathology Physician
Primary
475033
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2726668
—
MI
Enumeration date
01/23/2007
Last updated
12/17/2009
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