MEDICARE: GENEMARKERS 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

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1770909319
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GENEMARKERS LLC

Provider Business Mailing Address
First Line	:	126 E SOUTH ST
Second Line	:
City	:	KALAMAZOO
State	:	MI
Zip	:	49007-4810
Country	:	US
Telephone Number	:	269-337-4145
Fax Number	:	844-272-9914

Provider Business Practice Location Address
First Line	:	126 E SOUTH ST
Second Line	:
City	:	KALAMAZOO
State	:	MI
Zip	:	49007-4810
Country	:	US
Telephone Number	:	269-337-4145
Fax Number	:

Authorized Official
Title or Position	:	BUSINESS OFFICE MANAGER
Name	:	CHRISTIE LYNN DANDO
Credential	:	FACMPE
Telephone Number	:	269-337-4145

Provider Enumeration Date	:	03/06/2014
Last Update Date	:	12/05/2019

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