1306896063 NPI number — MICHIGAN MULTISPECIALTY PHYSICIANS-PATHOLOGY

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1306896063 NPI number — MICHIGAN MULTISPECIALTY PHYSICIANS-PATHOLOGY

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MICHIGAN MULTISPECIALTY PHYSICIANS-PATHOLOGY
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:
PATHOLOGY & LABORATORY MANAGEMENT ASSOCIATES
Provider Other Organization Name Type Code:
3
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:
1306896063
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 3499
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ANN ARBOR
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
48106-3499
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
734-712-5989
Provider Business Mailing Address Fax Number:
734-434-0330

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5301 E HURON RIVER DR
Provider Second Line Business Practice Location Address:
SJMH CLINICAL LABORATORY
Provider Business Practice Location Address City Name:
YPSILANTI
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48197-1051
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
734-712-5989
Provider Business Practice Location Address Fax Number:
734-434-0330
Provider Enumeration Date:
05/11/2006

Additional Information

Authorized Official

Authorized Official Last Name:
VALENSTEIN
Authorized Official First Name:
PAUL
Authorized Official Middle Name:
N
Authorized Official Title or Position:
DIVISION HEAD
Authorized Official Telephone Number:
734-712-4081

Provider Taxonomy Codes

  • Taxonomy code: 291U00000X , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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