Provider Demographics
NPI:1720118714
Name:LAKELAND PATHOLOGY
Entity Type:Organization
Organization Name:LAKELAND PATHOLOGY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:
Authorized Official - Last Name:UNCINI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:218-312-3002
Mailing Address - Street 1:1200 E 25TH STREET
Mailing Address - Street 2:
Mailing Address - City:HIBBING
Mailing Address - State:MN
Mailing Address - Zip Code:55746-2341
Mailing Address - Country:US
Mailing Address - Phone:218-312-3002
Mailing Address - Fax:218-312-3003
Practice Address - Street 1:750 E 34TH ST
Practice Address - Street 2:
Practice Address - City:HIBBING
Practice Address - State:MN
Practice Address - Zip Code:55746-2341
Practice Address - Country:US
Practice Address - Phone:218-312-3002
Practice Address - Fax:218-312-3003
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-07
Last Update Date:2010-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN29005207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical PathologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN14784LAOtherBLUE CROSS BLUE SHIELD
MNCS4970OtherRAILROAD MEDICARE
MN979273200Medicaid
MNC04150Medicare PIN