Provider Demographics
NPI:1013750710
Name:GENOMICMD, INC.
Entity type:Organization
Organization Name:GENOMICMD, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:JASON
Authorized Official - Middle Name:
Authorized Official - Last Name:LOBEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:877-760-4463
Mailing Address - Street 1:20 N WACKER DR FL 12
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60606-2806
Mailing Address - Country:US
Mailing Address - Phone:877-760-4463
Mailing Address - Fax:888-428-1106
Practice Address - Street 1:20 N WACKER DR FL 12
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60606-2806
Practice Address - Country:US
Practice Address - Phone:877-760-4463
Practice Address - Fax:888-428-1106
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-06-18
Last Update Date:2025-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory