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Organization

MICHIGAN MEDICAL LABORATORY LLC

Active
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Organization

MICHIGAN MEDICAL LABORATORY LLC

Active
Other names
dba National Laboratory
Organization subpart
No

Provider details

NPI number
Authorized official
ELIZABETH MARY KNISLEY CEO (CHIEF EXECUTIVE OFFICER)
(734) 502-4104
Entity
Organization

Contact information

Practice address
5732 ALEXIS ROAD, SYLVANIA, OH 43560
(248) 254-3950
(248) 254-3951
Mailing address
5732 ALEXIS ROAD, SYLVANIA, OH 43560
(248) 254-3950
(248) 254-3951

Taxonomy

Speciality
Code
Description
License number
State
291U00000X
Clinical Medical Laboratory
Primary
23D2063832
MI

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
0H28665
BCBSM
MI
01
OH28665
BLUE CROSS BLUE SHEILD
OH
Enumeration date
01/20/2014
Last updated
07/21/2022
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