Provider Demographics
NPI:1740731611
Name:GENETOX, LLC
Entity type:Organization
Organization Name:GENETOX, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SELAHATTIN
Authorized Official - Middle Name:
Authorized Official - Last Name:KURTER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:414-394-9402
Mailing Address - Street 1:10012 W CAPITOL DR
Mailing Address - Street 2:SUITE 202
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53222-1338
Mailing Address - Country:US
Mailing Address - Phone:414-394-9402
Mailing Address - Fax:
Practice Address - Street 1:10012 W CAPITOL DR
Practice Address - Street 2:SUITE 202
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53222-1338
Practice Address - Country:US
Practice Address - Phone:414-394-9402
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-10-17
Last Update Date:2017-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory