Provider Demographics
NPI:1619080009
Name:AMERICAN DERMPATH SPECIALISTS INC
Entity Type:Organization
Organization Name:AMERICAN DERMPATH SPECIALISTS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:MICHELLE
Authorized Official - Middle Name:
Authorized Official - Last Name:SCHLECKER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:954-421-3200
Mailing Address - Street 1:8130 ROYAL PALM BLVD
Mailing Address - Street 2:SUITE 201
Mailing Address - City:CORAL SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:33065-5703
Mailing Address - Country:US
Mailing Address - Phone:954-232-9479
Mailing Address - Fax:954-421-3201
Practice Address - Street 1:8130 ROYAL PALM BLVD
Practice Address - Street 2:SUITE 201
Practice Address - City:CORAL SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:33065-5703
Practice Address - Country:US
Practice Address - Phone:954-232-9479
Practice Address - Fax:954-421-3201
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-17
Last Update Date:2008-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL10D1023742291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLL9279OtherBLUE CROSS BLUE SHIELD
FLE9146Medicare PIN