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General NPI Number Information
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NPI Number | 1063754323
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Entity Type | Organization
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Legal Business Name | CLEARPATH DIAGNOSTICS LLC
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Dates
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Enumeration Date | 03/25/2013
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Last Update Date | 12/02/2013
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Provider Practice Location Address
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Address Line | 25354 EVERGREEN RD
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City | SOUTHFIELD
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State | MI
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Zip | 48075-1776
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Country | US
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Telephone | 248-402-1222
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Fax |
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Provider Business Mailing Address
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Address Line | 25354 EVERGREEN RD
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City | SOUTHFIELD
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State | MI
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Zip | 48075-1776
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Country | US
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Telephone | 248-402-1222
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Fax | 248-809-6865
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Authorized Official
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Title or Position | MANAGER
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Name | DR. WARREN RINGOLD
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Credential | M.D
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Telephone | 248-402-1222
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 293D00000X
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Taxonomy Name | Physiological Laboratory
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License Number | 63-C026
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License Number State | MI
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