Aivanta Labs LLC
Clinical Medical Laboratory in Farmington Hills, MI. Organization (NPI-2).
Details
- NPI
- 1689520108
- Entity type
- Organization (NPI-2)
- Legal business name
- Aivanta Labs LLC
- Organization subpart
- No
- Enumeration date
- Mar 6, 2026
- Certification date
- Apr 7, 2026
- Last updated
- Apr 7, 2026
Medicare and OIG
- Medicare enrolled (PECOS)
- Not in the Medicare enrollment file
- Can order and refer
- Not on the CMS order and referring list
- OIG exclusion list
- This NPI is not listed
CMS and OIG files of November 2026. PECOS lookup · OIG exclusion check
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 291U00000X | Clinical Medical Laboratory | – | – | Yes |
Practice location
37085 Grand River Ave Ste 1105Farmington Hills, MI 48335-2830
Phone 248-916-6381
Mailing address
37085 Grand River Ave Ste 1105Farmington Hills, MI 48335-2830
Phone 248-916-6381
Authorized official
Venkata Sai Pavan Kumar Guptha Gurram
Owner/Authorized Official
2489166381
Is something wrong?
This page shows exactly what the provider filed with NPPES. Only the provider (or their surrogate) can change it, by signing in to NPPES. Our page updates within a day of their change. See how to update NPI information.
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