Provider Demographics
NPI:1396773867
Name:PATHOLOGY ASSOCIATES OF MT CLEMENS PC
Entity type:Organization
Organization Name:PATHOLOGY ASSOCIATES OF MT CLEMENS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:MONROE
Authorized Official - Middle Name:H
Authorized Official - Last Name:ADAMS
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:586-493-8000
Mailing Address - Street 1:PO BOX 2416
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49501-2416
Mailing Address - Country:US
Mailing Address - Phone:586-493-8000
Mailing Address - Fax:586-493-8721
Practice Address - Street 1:1000 HARRINGTON BLVD
Practice Address - Street 2:
Practice Address - City:MT CLEMENS
Practice Address - State:MI
Practice Address - Zip Code:48043
Practice Address - Country:US
Practice Address - Phone:586-493-8000
Practice Address - Fax:586-493-8721
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-30
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical PathologyGroup - Multi-Specialty