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General NPI Number Information
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NPI Number | 1760287445
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Entity Type | Organization
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Legal Business Name | INFORM DIAGNOSTICS, INC.
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Dates
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Enumeration Date | 02/17/2025
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Last Update Date | 02/17/2025
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Provider Practice Location Address
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Address Line | 10393 PARKSIDE DR
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City | BRECKSVILLE
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State | OH
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Zip | 44141-3802
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Country | US
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Telephone | 888-290-5307
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Fax |
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Provider Business Mailing Address
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Address Line | 1111 S FREEPORT PKWY
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City | COPPELL
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State | TX
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Zip | 75019-4435
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Country | US
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Telephone | 888-290-5307
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Fax |
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Authorized Official
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Title or Position | VP, GENERAL MANAGER
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Name | RAYMOND CHRISTOPHER WICKER
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Credential |
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Telephone | 678-477-4402
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207NI0002X
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Taxonomy Name | Clinical & Laboratory Dermatological Immunology Physician
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License Number |
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License Number State |
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