Healthcare Provider Details

I. General information

NPI: 1063771012
Provider Name (Legal Business Name): DCL PATHOLOGY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/11/2012
Last Update Date: 05/16/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9550 ZIONSVILLE RD SUITE 200
INDIANAPOLIS IN
46268-1065
US

IV. Provider business mailing address

9550 ZIONSVILLE RD SUITE 200
INDIANAPOLIS IN
46268-1065
US

V. Phone/Fax

Practice location:
  • Phone: 317-874-1254
  • Fax: 317-872-4193
Mailing address:
  • Phone: 317-874-1254
  • Fax: 317-872-4193

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207ZC0500X
TaxonomyCytopathology Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207ZP0102X
TaxonomyAnatomic Pathology & Clinical Pathology Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. CAROL C EISENHUT
Title or Position: LAB DIRECTOR
Credential: MD
Phone: 317-874-1254