MEDICARE: DALLY DIAGNOSTICS 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	:	1073401956
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DALLY DIAGNOSTICS INC

Provider Business Mailing Address
First Line	:	4245 S BEECH DALY ST STE 201
Second Line	:
City	:	DEARBORN HEIGHTS
State	:	MI
Zip	:	48125-1576
Country	:	US
Telephone Number	:	888-650-5855
Fax Number	:

Provider Business Practice Location Address
First Line	:	4245 S BEECH DALY ST STE 201
Second Line	:
City	:	DEARBORN HEIGHTS
State	:	MI
Zip	:	48125-1576
Country	:	US
Telephone Number	:	888-650-5855
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	DAMARUKA SAI SEETHA RAM CHIMMA
Credential	:
Telephone Number	:	945-392-6240

Provider Enumeration Date	:	06/27/2025
Last Update Date	:	03/27/2026

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