Healthcare Provider Details

I. General information

NPI: 1477158020
Provider Name (Legal Business Name): BASE10 GENETICS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/02/2020
Last Update Date: 08/10/2021
Certification Date: 08/10/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

70 E LAKE ST STE 226
CHICAGO IL
60601-7650
US

IV. Provider business mailing address

70 E LAKE ST STE 226
CHICAGO IL
60601-7650
US

V. Phone/Fax

Practice location:
  • Phone: 866-710-1018
  • Fax:
Mailing address:
  • Phone: 866-710-1018
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: CATHERINE ANTOINETTE FETZER
Title or Position: VICE PRESIDENT STRATEGIC OPERATIONS
Credential:
Phone: 215-327-7222