Provider Demographics
NPI:1942254909
Name:NORTHWEST PATHOLOGY CONSULTANTS PC
Entity Type:Organization
Organization Name:NORTHWEST PATHOLOGY CONSULTANTS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:
Authorized Official - Last Name:EDELMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:248-858-3190
Mailing Address - Street 1:PO BOX 670114
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48267-0114
Mailing Address - Country:US
Mailing Address - Phone:248-858-3197
Mailing Address - Fax:248-858-3148
Practice Address - Street 1:44405 WOODWARD AVENUE
Practice Address - Street 2:ST JOSEPH MERCY HOSPITAL
Practice Address - City:PONTIAC
Practice Address - State:MI
Practice Address - Zip Code:48341-2985
Practice Address - Country:US
Practice Address - Phone:248-858-3190
Practice Address - Fax:248-858-3148
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-22
Last Update Date:2022-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical PathologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI220F36272OtherBLUE CROSS BLUE SHEILD
MI0F36272OtherMEDICARE