Provider Demographics
NPI:1922089242
Name:PATHOLOGY CONSULTANTS OF SOUTH BROWARD, LLP
Entity Type:Organization
Organization Name:PATHOLOGY CONSULTANTS OF SOUTH BROWARD, LLP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF OPERATING OFFICER
Authorized Official - Prefix:DR
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:ALLEN
Authorized Official - Last Name:MALEK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:954-985-5921
Mailing Address - Street 1:9581 PREMIER PKWY
Mailing Address - Street 2:
Mailing Address - City:MIRAMAR
Mailing Address - State:FL
Mailing Address - Zip Code:33025-3206
Mailing Address - Country:US
Mailing Address - Phone:954-276-1864
Mailing Address - Fax:954-967-7630
Practice Address - Street 1:3501 JOHNSON ST
Practice Address - Street 2:
Practice Address - City:HOLLYWOOD
Practice Address - State:FL
Practice Address - Zip Code:33021-5421
Practice Address - Country:US
Practice Address - Phone:954-985-5921
Practice Address - Fax:954-985-3471
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-14
Last Update Date:2022-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical PathologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL266244201Medicaid
FL266244203Medicaid
FL266244200Medicaid
FL266244202Medicaid
FL266244200Medicaid