1326008699 NPI number — MAINWARING PATHOLOGY GROUP PC

Table of content: (NPI 1326008699)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1326008699 NPI number — MAINWARING PATHOLOGY GROUP PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MAINWARING PATHOLOGY GROUP PC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1326008699
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 32615
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
DETROIT
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
48232-0615
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
313-593-7965
Provider Business Mailing Address Fax Number:
313-593-7143

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
18101 OAKWOOD BLVD
Provider Second Line Business Practice Location Address:
OAKWOOD HOSPITAL MEDICAL CENTER
Provider Business Practice Location Address City Name:
DEARBORN
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48124
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
313-593-7965
Provider Business Practice Location Address Fax Number:
313-593-7143
Provider Enumeration Date:
03/23/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
SCHALDENBRAND
Authorized Official First Name:
MICHAEL
Authorized Official Middle Name:
F
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
313-593-7965

Provider Taxonomy Codes

  • Taxonomy code: 207ZP0102X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 220H26182 . This is a "BCBSH" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".