Provider Demographics
NPI:1720192362
Name:OPTIMUM PATHOLOGY SERVICES PLLC
Entity Type:Organization
Organization Name:OPTIMUM PATHOLOGY SERVICES PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:BERTE
Authorized Official - Middle Name:J
Authorized Official - Last Name:BAKER
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:734-674-6403
Mailing Address - Street 1:PO BOX 77000
Mailing Address - Street 2:DEPT 78309
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48278-0309
Mailing Address - Country:US
Mailing Address - Phone:734-674-6403
Mailing Address - Fax:734-282-6397
Practice Address - Street 1:1500 EUREKA ROAD
Practice Address - Street 2:
Practice Address - City:WYANDOTTE
Practice Address - State:MI
Practice Address - Zip Code:48192
Practice Address - Country:US
Practice Address - Phone:734-674-6403
Practice Address - Fax:734-282-6397
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-19
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical PathologyGroup - Single Specialty