Provider Demographics
NPI:1902277353
Name:PRUDENT DIAGNOSTICS LABORATORIES
Entity Type:Organization
Organization Name:PRUDENT DIAGNOSTICS LABORATORIES
Other - Org Name:MEDICAL LABORATORIES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:MAJID
Authorized Official - Middle Name:
Authorized Official - Last Name:MORIDANI
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:414-949-1355
Mailing Address - Street 1:2564 N 124TH ST APT 412
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53226-1050
Mailing Address - Country:US
Mailing Address - Phone:414-949-1355
Mailing Address - Fax:
Practice Address - Street 1:2564 N 124TH ST APT 412
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53226-1050
Practice Address - Country:US
Practice Address - Phone:414-949-1355
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-10-12
Last Update Date:2015-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory