MEDICARE: GENESIS DIAGNOSTIC SERVICES INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	291U00000X	Clinical Medical Laboratory

General Provider Information

NPI Number	:	1326694670
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GENESIS DIAGNOSTIC SERVICES INC

Provider Business Mailing Address
First Line	:	12150 SHILOH RD STE 124
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75228-1548
Country	:	US
Telephone Number	:	214-619-8550
Fax Number	:	214-853-4109

Provider Business Practice Location Address
First Line	:	12150 SHILOH RD STE 124
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75228-1548
Country	:	US
Telephone Number	:	214-619-8550
Fax Number	:	214-853-4109

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. SYED NAVEED
Credential	:	MD
Telephone Number	:	630-776-5027

Provider Enumeration Date	:	08/13/2019
Last Update Date	:	02/25/2026

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