Healthcare Provider Details

I. General information

NPI: 1225000201
Provider Name (Legal Business Name): AMERIPATH INSTITUTE OF UROLOGICAL PATHOLOGY PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/03/2006
Last Update Date: 03/19/2012
Certification Date:
Deactivation Date: 01/04/2011
Reactivation Date: 03/19/2012

III. Provider practice location address

27472 SCHOENHERR RD SUITE 100
WARREN MI
48088-6688
US

IV. Provider business mailing address

7111 FAIRWAY DR SUITE 400
PALM BEACH GARDENS FL
33418-4207
US

V. Phone/Fax

Practice location:
  • Phone: 586-774-5819
  • Fax: 586-774-5869
Mailing address:
  • Phone: 561-712-6265
  • Fax: 561-712-7349

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code291U00000X
TaxonomyClinical Medical Laboratory
License Number23D1024436
License Number StateMI

VIII. Authorized Official

Name: MR. MICHEL H GREENE
Title or Position: VP
Credential:
Phone: 214-932-8270