NPI 1255442190

Life- Alysis Kidney Center, LLC

Organisation Health Maintenance Organization Detroit, MI

Practice location

Address: 5830 Conner St, Detroit, MI 48213-3458
Phone: (313) 371-5433
Fax: (313) 371-6937

Authorised official

Name: Lyle Maruice Gray
Title: Partner
Phone: (313) 371-5433

Registered specialties

Health Maintenance Organization Primary

Managed Care Organizations Taxonomy 302R00000X Licence 302R00000X (MI)

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Registry record

NPI: 1255442190
Entity type: Organization
NPI issued: 31 Aug 2006
Record last updated: 23 Jan 2013

Reproduced from NPPES, the federal provider registry. The date above is when the provider last updated their own entry, not when we fetched it - a record can be years old and still current in the registry.