Provider Demographics
NPI:1700064953
Name:CANDU LAB SERVICES
Entity type:Organization
Organization Name:CANDU LAB SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:NICOLAE
Authorized Official - Middle Name:
Authorized Official - Last Name:CANDU
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:260-804-6727
Mailing Address - Street 1:2118 INWOOD DR
Mailing Address - Street 2:SUITE 121
Mailing Address - City:FORT WAYNE
Mailing Address - State:IN
Mailing Address - Zip Code:46815-7115
Mailing Address - Country:US
Mailing Address - Phone:260-804-6727
Mailing Address - Fax:260-918-0218
Practice Address - Street 1:2118 INWOOD DR
Practice Address - Street 2:SUITE 121
Practice Address - City:FORT WAYNE
Practice Address - State:IN
Practice Address - Zip Code:46815-7115
Practice Address - Country:US
Practice Address - Phone:260-804-6727
Practice Address - Fax:260-918-0218
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-08
Last Update Date:2008-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory