MEDICARE: KSL 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	:	1528539459
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	KSL DIAGNOSTICS INC

Provider Business Mailing Address
First Line	:	55 AMHERST VILLA RD STE 2
Second Line	:
City	:	BUFFALO
State	:	NY
Zip	:	14225-1400
Country	:	US
Telephone Number	:	800-960-1080
Fax Number	:

Provider Business Practice Location Address
First Line	:	55 AMHERST VILLA RD STE 2
Second Line	:
City	:	BUFFALO
State	:	NY
Zip	:	14225-1400
Country	:	US
Telephone Number	:	800-960-1080
Fax Number	:

Authorized Official
Title or Position	:	CSO
Name	:	DR. LAKSHMANAN SURESH
Credential	:	DDS, MS,PHD.
Telephone Number	:	800-960-1080

Provider Enumeration Date	:	12/17/2018
Last Update Date	:	06/20/2025

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Directions to “KSL DIAGNOSTICS INC ” Practice Location

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