Provider Demographics
NPI:1023185162
Name:COVENANT PATHOLOGY ASSOCIATES, PC
Entity Type:Organization
Organization Name:COVENANT PATHOLOGY ASSOCIATES, PC
Other - Org Name:MI HEALTH CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:L
Authorized Official - Last Name:STOCKMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:989-459-2300
Mailing Address - Street 1:3925 FORTUNE BLVD
Mailing Address - Street 2:
Mailing Address - City:SAGINAW
Mailing Address - State:MI
Mailing Address - Zip Code:48603-2287
Mailing Address - Country:US
Mailing Address - Phone:989-459-2300
Mailing Address - Fax:
Practice Address - Street 1:3925 FORTUNE BLVD
Practice Address - Street 2:
Practice Address - City:SAGINAW
Practice Address - State:MI
Practice Address - Zip Code:48603-2287
Practice Address - Country:US
Practice Address - Phone:989-459-2300
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-30
Last Update Date:2022-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical PathologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI38068OtherCOMMUNITY CHOICE MI
MI1009460OtherMCLAREN HEALTH PLAN
MICI9309OtherRAILROAD MEDICARE
MI02833OtherPRIORITY HEALTH
MI029611OtherMIDWEST HEALTH PLAN
MI0G31049OtherBLUE CROSS BLUE SHIELD MI
MI50011958OtherHAP
MI0985739OtherHEALTHPLUS MI
MI136122100OtherUS DEPT OF LABOR WORKCOMP
MILP730004OtherM-CARE