Healthcare Provider Details

I. General information

NPI: 1932159118
Provider Name (Legal Business Name): MICRO PATH LABORATORIES INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/11/2006
Last Update Date: 02/02/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1125 BARTOW RD SUITE 101
LAKELAND FL
33801-5852
US

IV. Provider business mailing address

1125 BARTOW RD SUITE 101
LAKELAND FL
33801-5852
US

V. Phone/Fax

Practice location:
  • Phone: 863-683-7171
  • Fax: 863-687-0742
Mailing address:
  • Phone: 863-683-7171
  • Fax: 863-687-0742

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code291U00000X
TaxonomyClinical Medical Laboratory
License Number800000683
License Number StateFL

VIII. Authorized Official

Name: DR. CRAIG D LARISCY
Title or Position: PRESIDENT
Credential: M.D.
Phone: 863-683-7171