Healthcare Provider Details

I. General information

NPI: 1588955926
Provider Name (Legal Business Name): MIRIAM RENEE CONCES
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/19/2011
Last Update Date: 05/29/2026
Certification Date: 05/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

700 CHILDRENS DR
COLUMBUS OH
43205-2664
US

IV. Provider business mailing address

PO BOX 78000
DETROIT MI
48278-1676
US

V. Phone/Fax

Practice location:
  • Phone: 614-722-5315
  • Fax: 614-355-1597
Mailing address:
  • Phone: 614-722-5315
  • Fax: 614-355-1597

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207ZP0102X
TaxonomyAnatomic Pathology & Clinical Pathology Physician
License Number35.128409
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code207ZP0213X
TaxonomyPediatric Pathology Physician
License Number35.128409
License Number StateOH
# 3
Primary TaxonomyN
Taxonomy Code207ZP0102X
TaxonomyAnatomic Pathology & Clinical Pathology Physician
License Number0101258565
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: