Provider Demographics
NPI:1114959665
Name:MCD PATHOLOGY LLP
Entity Type:Organization
Organization Name:MCD PATHOLOGY LLP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:JO ELLEN
Authorized Official - Middle Name:
Authorized Official - Last Name:KRUEGER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:972-566-7283
Mailing Address - Street 1:7777 FOREST LANE
Mailing Address - Street 2:DEPARTMENT OF PATHOLOGY
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75230-2584
Mailing Address - Country:US
Mailing Address - Phone:972-566-7283
Mailing Address - Fax:792-566-7183
Practice Address - Street 1:7777 FOREST LANE
Practice Address - Street 2:DEPARTMENT OF PATHOLOGY
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75230-2584
Practice Address - Country:US
Practice Address - Phone:972-566-7283
Practice Address - Fax:792-566-7183
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-07
Last Update Date:2022-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical PathologyGroup - Single Specialty
No207ZP0007XAllopathic & Osteopathic PhysiciansPathologyMolecular Genetic PathologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXPM89OtherBLUE CROSS
TX120722702Medicaid
TXPM89Medicare ID - Type Unspecified