Provider Demographics
NPI:1184896425
Name:I PATHOLOGY LLC
Entity type:Organization
Organization Name:I PATHOLOGY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MUNEAR
Authorized Official - Middle Name:ASHTON
Authorized Official - Last Name:KOUZBARI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:214-682-8536
Mailing Address - Street 1:6850 NEW TAMPA HWY STE 500
Mailing Address - Street 2:
Mailing Address - City:LAKELAND
Mailing Address - State:FL
Mailing Address - Zip Code:33815-3168
Mailing Address - Country:US
Mailing Address - Phone:863-606-6655
Mailing Address - Fax:863-583-9584
Practice Address - Street 1:6850 NEW TAMPA HWY STE 500
Practice Address - Street 2:
Practice Address - City:LAKELAND
Practice Address - State:FL
Practice Address - Zip Code:33815-3168
Practice Address - Country:US
Practice Address - Phone:863-606-6655
Practice Address - Fax:863-583-9584
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-27
Last Update Date:2023-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL000135500Medicaid
FLAK326Medicare PIN