MEDICARE: PEAK HEALTH DIAGNOSTICS, LLC

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	:	1760061352
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PEAK HEALTH DIAGNOSTICS, LLC

Provider Business Mailing Address
First Line	:	1605 N GARLAND AVE STE A
Second Line	:
City	:	GARLAND
State	:	TX
Zip	:	75040-9418
Country	:	US
Telephone Number	:	312-434-9239
Fax Number	:

Provider Business Practice Location Address
First Line	:	1605 N GARLAND AVE STE A
Second Line	:
City	:	GARLAND
State	:	TX
Zip	:	75040-9418
Country	:	US
Telephone Number	:	312-434-9239
Fax Number	:

Authorized Official
Title or Position	:	AUTHORIZED OFFICIAL
Name	:	MOHAMMED IMRAN
Credential	:
Telephone Number	:	312-434-9239

Provider Enumeration Date	:	04/02/2021
Last Update Date	:	06/16/2023

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