Provider Demographics
NPI:1932843836
Name:ELIXIR DIAGNOSTICS, LLC
Entity type:Organization
Organization Name:ELIXIR DIAGNOSTICS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:ALI
Authorized Official - Middle Name:
Authorized Official - Last Name:SIDDIQUI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:561-635-0392
Mailing Address - Street 1:17115 RED OAK DR STE 123
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77090-2607
Mailing Address - Country:US
Mailing Address - Phone:979-487-8258
Mailing Address - Fax:832-413-0059
Practice Address - Street 1:17115 RED OAK DR STE 123
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77090-2607
Practice Address - Country:US
Practice Address - Phone:979-487-8258
Practice Address - Fax:832-413-0059
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-04-26
Last Update Date:2022-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory