MEDICARE: IDBYDNA 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	:	1750915658
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	IDBYDNA INC.

Provider Business Mailing Address
First Line	:	675 S ARAPEEN DR STE 301
Second Line	:
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84108-1223
Country	:	US
Telephone Number	:	801-983-8330
Fax Number	:

Provider Business Practice Location Address
First Line	:	675 S ARAPEEN DR STE 301
Second Line	:
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84108-1223
Country	:	US
Telephone Number	:	801-983-8330
Fax Number	:

Authorized Official
Title or Position	:	CHIEF MEDICAL OFFICER
Name	:	DR. ROBERT SCHLABERG
Credential	:	MD
Telephone Number	:	801-983-8330

Provider Enumeration Date	:	02/28/2020
Last Update Date	:	02/28/2020

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