MEDICARE: UNIVERSITY PATHOLOGISTS CONSULTANTS, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	291U00000X	Clinical Medical Laboratory

General Provider Information

NPI Number	:	1568423184
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	UNIVERSITY PATHOLOGISTS CONSULTANTS, LLC

Provider Business Mailing Address
First Line	:	5700 SOUTHWYCK BLVD
Second Line	:
City	:	TOLEDO
State	:	OH
Zip	:	43614-1509
Country	:	US
Telephone Number	:	800-288-8325
Fax Number	:	419-866-5453

Provider Business Practice Location Address
First Line	:	1750 W HARRISON ST
Second Line	:	JELKE BUILDING ROOM 1124
City	:	CHICAGO
State	:	IL
Zip	:	60612-3825
Country	:	US
Telephone Number	:	312-942-8848
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. ROBERT DECRESCE
Credential	:	MD
Telephone Number	:	312-942-8848

Provider Enumeration Date	:	03/31/2006
Last Update Date	:	10/31/2013

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