=====================================================
General NPI Number Information
=====================================================
NPI Number | 1265371439
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | DATA MINT LABS LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/25/2026
-----------------------------------------------------
Last Update Date | 03/25/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 37250 PLYMOUTH RD STE 6
-----------------------------------------------------
City | LIVONIA
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 48150-1138
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 661-301-9257
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 37250 PLYMOUTH RD STE 6
-----------------------------------------------------
City | LIVONIA
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 48150-1138
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 661-301-9257
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER/AUTHORIZED OFFICIAL
-----------------------------------------------------
Name | AVINASH REDDY PADKANTI
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 661-301-9257
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 291U00000X
-----------------------------------------------------
Taxonomy Name | Clinical Medical Laboratory
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------