Provider Demographics
NPI:1326008699
Name:MAINWARING PATHOLOGY GROUP PC
Entity Type:Organization
Organization Name:MAINWARING PATHOLOGY GROUP PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:F
Authorized Official - Last Name:SCHALDENBRAND
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:313-593-7965
Mailing Address - Street 1:PO BOX 32615
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48232-0615
Mailing Address - Country:US
Mailing Address - Phone:313-593-7965
Mailing Address - Fax:313-593-7143
Practice Address - Street 1:18101 OAKWOOD BLVD
Practice Address - Street 2:OAKWOOD HOSPITAL MEDICAL CENTER
Practice Address - City:DEARBORN
Practice Address - State:MI
Practice Address - Zip Code:48124
Practice Address - Country:US
Practice Address - Phone:313-593-7965
Practice Address - Fax:313-593-7143
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-23
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical PathologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI220H26182OtherBCBSH
MI220H26182OtherBCBSH