Healthcare Provider Details

I. General information

NPI: 1346223377
Provider Name (Legal Business Name): PINKUS DERMATOPATHOLOGY LABORATORY, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/23/2005
Last Update Date: 02/01/2024
Certification Date: 02/01/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1314 N MACOMB ST
MONROE MI
48162-3131
US

IV. Provider business mailing address

1355 RIVER BEND DR
DALLAS TX
75247-4915
US

V. Phone/Fax

Practice location:
  • Phone: 734-242-6872
  • Fax: 734-242-4962
Mailing address:
  • Phone: 734-242-6872
  • Fax: 734-242-4962

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207ZP0102X
TaxonomyAnatomic Pathology & Clinical Pathology Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code291U00000X
TaxonomyClinical Medical Laboratory
License Number
License Number State

VIII. Authorized Official

Name: DINA VALLADARES
Title or Position: DIRECTOR
Credential:
Phone: 561-514-5822