Provider Demographics
NPI:1194018770
Name:DEPARTMENT OF PATHOLOGY, IMMUNOLOGY AND LABORATORY MEDICINE
Entity Type:Organization
Organization Name:DEPARTMENT OF PATHOLOGY, IMMUNOLOGY AND LABORATORY MEDICINE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ASSOCIATE DEAN OF GM
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:MAHLA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:352-273-8909
Mailing Address - Street 1:1329 SW 16TH ST
Mailing Address - Street 2:ROOM 4230
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32608-1128
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1329 SW 16TH ST
Practice Address - Street 2:ROOM 4230
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32608-1128
Practice Address - Country:US
Practice Address - Phone:352-265-0680
Practice Address - Fax:352-265-7978
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-05-16
Last Update Date:2011-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
No261Q00000XAmbulatory Health Care FacilitiesClinic/Center
No282N00000XHospitalsGeneral Acute Care Hospital