MEDICARE: TITAN GENOMICS, 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	:	1942888672
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TITAN GENOMICS, LLC

Provider Business Mailing Address
First Line	:	1818 S AUSTRALIAN AVE STE 410
Second Line	:
City	:	WEST PALM BEACH
State	:	FL
Zip	:	33409-6447
Country	:	US
Telephone Number	:	561-328-8639
Fax Number	:

Provider Business Practice Location Address
First Line	:	1818 S AUSTRALIAN AVE STE 410
Second Line	:
City	:	WEST PALM BEACH
State	:	FL
Zip	:	33409-6447
Country	:	US
Telephone Number	:	561-328-8639
Fax Number	:	561-617-9255

Authorized Official
Title or Position	:	OWNER/CEO
Name	:	DR. ELAN COLEN
Credential	:	MD
Telephone Number	:	310-666-0815

Provider Enumeration Date	:	04/01/2021
Last Update Date	:	04/01/2021

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