Healthcare Provider Details

I. General information

NPI: 1538538178
Provider Name (Legal Business Name): SPECIALIZED PATHOLOGY PARTNERS PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/24/2015
Last Update Date: 01/04/2022
Certification Date: 01/04/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3925 FORTUNE BLVD
SAGINAW MI
48603-2287
US

IV. Provider business mailing address

3925 FORTUNE BLVD
SAGINAW MI
48603-2287
US

V. Phone/Fax

Practice location:
  • Phone: 989-459-2300
  • Fax: 989-499-7090
Mailing address:
  • Phone: 989-459-2300
  • Fax: 989-499-7090

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207ND0900X
TaxonomyDermatopathology Physician
License Number
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code207ZC0500X
TaxonomyCytopathology Physician
License Number4301108678
License Number StateMI
# 3
Primary TaxonomyN
Taxonomy Code207ZD0900X
TaxonomyDermatopathology (Pathology) Physician
License Number
License Number StateMI
# 4
Primary TaxonomyN
Taxonomy Code207ZP0007X
TaxonomyMolecular Genetic Pathology (Pathology) Physician
License Number
License Number StateMI
# 5
Primary TaxonomyY
Taxonomy Code207ZP0101X
TaxonomyAnatomic Pathology Physician
License Number
License Number StateMI
# 6
Primary TaxonomyN
Taxonomy Code207ZP0102X
TaxonomyAnatomic Pathology & Clinical Pathology Physician
License Number
License Number StateMI
# 7
Primary TaxonomyN
Taxonomy Code207ZP0213X
TaxonomyPediatric Pathology Physician
License Number
License Number StateMI
# 8
Primary TaxonomyN
Taxonomy Code291U00000X
TaxonomyClinical Medical Laboratory
License Number
License Number StateMI

VIII. Authorized Official

Name: DR. DAVID L STOCKMAN
Title or Position: DIRECTOR
Credential: M.D.
Phone: 989-341-5073