Provider Demographics
NPI:1346524345
Name:MANGINI DERMATOPATHOLOGY PLLC
Entity Type:Organization
Organization Name:MANGINI DERMATOPATHOLOGY PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:JANINE
Authorized Official - Middle Name:
Authorized Official - Last Name:MANGINI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:586-690-8983
Mailing Address - Street 1:42469 GARFIELD RD
Mailing Address - Street 2:
Mailing Address - City:CLINTON TOWNSHIP
Mailing Address - State:MI
Mailing Address - Zip Code:48038-1651
Mailing Address - Country:US
Mailing Address - Phone:586-690-8983
Mailing Address - Fax:586-690-8984
Practice Address - Street 1:42469 GARFIELD RD
Practice Address - Street 2:
Practice Address - City:CLINTON TOWNSHIP
Practice Address - State:MI
Practice Address - Zip Code:48038-1651
Practice Address - Country:US
Practice Address - Phone:586-690-8983
Practice Address - Fax:586-690-8984
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-10-09
Last Update Date:2012-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI291U00000XOtherTAXONOMY