Healthcare Provider Details

I. General information

NPI: 1649273459
Provider Name (Legal Business Name): HISTOLOGY ASSOCIATES INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/24/2005
Last Update Date: 07/28/2026
Certification Date: 07/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

29430 FORD RD
GARDEN CITY MI
48135-2318
US

IV. Provider business mailing address

29430 FORD RD
GARDEN CITY MI
48135-2318
US

V. Phone/Fax

Practice location:
  • Phone: 313-979-0792
  • Fax: 586-774-4220
Mailing address:
  • Phone: 313-979-0792
  • Fax: 586-774-4220

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207ZC0006X
TaxonomyClinical Pathology Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code291U00000X
TaxonomyClinical Medical Laboratory
License Number
License Number State

VIII. Authorized Official

Name: FADLALLAH KASSEM
Title or Position: OWNER
Credential:
Phone: 313-979-0792