Provider Demographics
NPI:1568563336
Name:HILBRICH DERMATOPATHOLOGY LABORATORY PC
Entity Type:Organization
Organization Name:HILBRICH DERMATOPATHOLOGY LABORATORY PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT LAB DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:ANDREW
Authorized Official - Last Name:HILBRICH
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:734-762-0500
Mailing Address - Street 1:32669 W WARREN RD STE 10
Mailing Address - Street 2:
Mailing Address - City:GARDEN CITY
Mailing Address - State:MI
Mailing Address - Zip Code:48135
Mailing Address - Country:US
Mailing Address - Phone:734-762-0500
Mailing Address - Fax:734-762-0530
Practice Address - Street 1:32669 W WARREN RD STE 10
Practice Address - Street 2:
Practice Address - City:GARDEN CITY
Practice Address - State:MI
Practice Address - Zip Code:48135
Practice Address - Country:US
Practice Address - Phone:734-762-0500
Practice Address - Fax:734-762-0530
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-26
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAP CERT # 7067601291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
H19420Medicare UPIN
0N53720Medicare ID - Type Unspecified