Provider Demographics
NPI:1972234987
Name:BWPG LYKOS LABS LLC
Entity Type:Organization
Organization Name:BWPG LYKOS LABS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:GABRIEL
Authorized Official - Middle Name:GROUP
Authorized Official - Last Name:BIEN-WILLNER
Authorized Official - Suffix:
Authorized Official - Credentials:MD, PHD
Authorized Official - Phone:832-687-8555
Mailing Address - Street 1:26797 HANNA RD BLDG 4D1
Mailing Address - Street 2:
Mailing Address - City:OAK RIDGE NORTH
Mailing Address - State:TX
Mailing Address - Zip Code:77385-6628
Mailing Address - Country:US
Mailing Address - Phone:346-831-0189
Mailing Address - Fax:
Practice Address - Street 1:26797 HANNA RD BLDG 4D1
Practice Address - Street 2:
Practice Address - City:OAK RIDGE NORTH
Practice Address - State:TX
Practice Address - Zip Code:77385-6628
Practice Address - Country:US
Practice Address - Phone:346-831-0189
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-06-21
Last Update Date:2022-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207ZP0007XAllopathic & Osteopathic PhysiciansPathologyMolecular Genetic PathologyGroup - Single Specialty