Healthcare Provider Details

I. General information

NPI: 1306919527
Provider Name (Legal Business Name): CYTOLOGY PATHOLOGY SERVICES INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/16/2006
Last Update Date: 06/10/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5865 MICHIGAN RD
INDIANAPOLIS IN
46228-1740
US

IV. Provider business mailing address

5865 MICHIGAN RD
INDIANAPOLIS IN
46228-1740
US

V. Phone/Fax

Practice location:
  • Phone: 317-255-3579
  • Fax: 317-255-3530
Mailing address:
  • Phone: 317-255-3579
  • Fax: 317-255-3530

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code291U00000X
TaxonomyClinical Medical Laboratory
License Number50002033A
License Number StateIN

VIII. Authorized Official

Name: DR. PIETER WIERSEMA
Title or Position: LABORATORY DIRECTOR
Credential: MD
Phone: 317-255-3579