MEDICARE: MEDICAL DNA LABS, 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

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1821409756
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MEDICAL DNA LABS, LLC

Provider Business Mailing Address
First Line	:	PO BOX 205213
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75320-5213
Country	:	US
Telephone Number	:	813-769-8810
Fax Number	:

Provider Business Practice Location Address
First Line	:	501 N REO ST
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33609-1012
Country	:	US
Telephone Number	:	813-769-8810
Fax Number	:

Authorized Official
Title or Position	:	CHIEF ADMINISTRATIVE OFFICER
Name	:	TRACIE GARI
Credential	:
Telephone Number	:	813-549-2134

Provider Enumeration Date	:	05/14/2014
Last Update Date	:	09/20/2025

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