MEDICARE: INTEGRON LLC

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	:	1376910018
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	INTEGRON LLC

Provider Business Mailing Address
First Line	:	5139 SHARP STREET
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75247
Country	:	US
Telephone Number	:	214-225-1230
Fax Number	:

Provider Business Practice Location Address
First Line	:	5139 SHARP STREET
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75247
Country	:	US
Telephone Number	:	214-225-1230
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	MR. KYLE JOSEPH KOEPPLER
Credential	:
Telephone Number	:	920-217-3519

Provider Enumeration Date	:	08/28/2015
Last Update Date	:	05/23/2019

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Directions to “INTEGRON LLC ” Practice Location

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