Healthcare Provider Details

I. General information

NPI: 1922386325
Provider Name (Legal Business Name): DCL PATHOLOGY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/02/2011
Last Update Date: 06/08/2012
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 TaxonomyY
Taxonomy Code291U00000X
TaxonomyClinical Medical Laboratory
License Number
License Number State

VIII. Authorized Official

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