MEDICARE: GENOMICMD, INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	291U00000X	Clinical Medical Laboratory

General Provider Information

NPI Number	:	1013750710
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GENOMICMD, INC.

Provider Business Mailing Address
First Line	:	20 N WACKER DR FL 12
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60606-2806
Country	:	US
Telephone Number	:	877-760-4463
Fax Number	:	888-428-1106

Provider Business Practice Location Address
First Line	:	20 N WACKER DR FL 12
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60606-2806
Country	:	US
Telephone Number	:	877-760-4463
Fax Number	:	888-428-1106

Authorized Official
Title or Position	:	CEO
Name	:	MR. JASON LOBEL
Credential	:
Telephone Number	:	877-760-4463

Provider Enumeration Date	:	06/18/2024
Last Update Date	:	04/25/2025

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