MEDICARE: SYNTHESIOM 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	:	1467240390
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SYNTHESIOM LLC

Provider Business Mailing Address
First Line	:	13155 NOEL RD STE 200
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75240-5021
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	13155 NOEL RD STE 200
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75240-5021
Country	:	US
Telephone Number	:	502-907-8553
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	CHARAN MUNAGALA
Credential	:
Telephone Number	:	502-907-8553

Provider Enumeration Date	:	04/29/2025
Last Update Date	:	11/03/2025

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Directions to “SYNTHESIOM LLC ” Practice Location

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