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General NPI Number Information
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NPI Number | 1326283276
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Entity Type | Organization
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Legal Business Name | GENESIS GENETICS INSTITUTE, LLC
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Dates
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Enumeration Date | 12/06/2008
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Last Update Date | 12/06/2008
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Provider Practice Location Address
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Address Line | 1380 E JEFFERSON AVE
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City | DETROIT
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State | MI
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Zip | 48207-3104
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Country | US
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Telephone | 313-579-9650
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Fax |
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Provider Business Mailing Address
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Address Line | 1380 E JEFFERSON AVE
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City | DETROIT
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State | MI
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Zip | 48207-3104
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Country | US
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Telephone | 313-579-9650
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Fax |
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Authorized Official
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Title or Position | MANAGING PARTNER
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Name | DR. MARK HUGHES
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Credential | MD, PH.D
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Telephone | 313-579-9650
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 291U00000X
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Taxonomy Name | Clinical Medical Laboratory
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License Number | H4426
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License Number State | MI
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