Provider Demographics
NPI:1225000201
Name:AMERIPATH INSTITUTE OF UROLOGICAL PATHOLOGY PC
Entity Type:Organization
Organization Name:AMERIPATH INSTITUTE OF UROLOGICAL PATHOLOGY PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VP
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHEL
Authorized Official - Middle Name:H
Authorized Official - Last Name:GREENE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:214-932-8270
Mailing Address - Street 1:7111 FAIRWAY DR
Mailing Address - Street 2:SUITE 400
Mailing Address - City:PALM BEACH GARDENS
Mailing Address - State:FL
Mailing Address - Zip Code:33418-4207
Mailing Address - Country:US
Mailing Address - Phone:561-712-6265
Mailing Address - Fax:561-712-7349
Practice Address - Street 1:27472 SCHOENHERR RD
Practice Address - Street 2:SUITE 100
Practice Address - City:WARREN
Practice Address - State:MI
Practice Address - Zip Code:48088-6688
Practice Address - Country:US
Practice Address - Phone:586-774-5819
Practice Address - Fax:586-774-5869
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:AMERIPATH INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-02-03
Last Update Date:2012-03-19
Deactivation Date:2011-01-04
Deactivation Code:
Reactivation Date:2012-03-19
Provider Licenses
StateLicense IDTaxonomies
MI23D1024436291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCL00236Medicaid
MI4727299Medicaid
MI0E01779OtherBC/BS OF MICHIGAN
SCL00236Medicaid