Healthcare Provider Details

I. General information

NPI: 1750299756
Provider Name (Legal Business Name): AXION DIAGNOSTICS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/31/2026
Last Update Date: 08/31/2026
Certification Date: 08/31/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

900 SE OCEAN BLVD STE D232
STUART FL
34994-3501
US

IV. Provider business mailing address

900 SE OCEAN BLVD
STUART FL
34994-2471
US

V. Phone/Fax

Practice location:
  • Phone: 772-244-4534
  • Fax:
Mailing address:
  • Phone: 772-244-4534
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code291U00000X
TaxonomyClinical Medical Laboratory
License Number
License Number State

VIII. Authorized Official

Name: SHIRLEY KOHL
Title or Position: OWNER
Credential:
Phone: 772-286-3505