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General NPI Number Information
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NPI Number | 1114550175
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Entity Type | Organization
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Legal Business Name | LUMINOUS PATHOLOGY ASSOCIATES LLC
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Dates
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Enumeration Date | 02/19/2020
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Last Update Date | 02/20/2020
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Provider Practice Location Address
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Address Line | 5909 WEST LOOP S STE 310
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City | BELLAIRE
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State | TX
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Zip | 77401-2402
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Country | US
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Telephone | 713-542-8592
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Fax |
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Provider Business Mailing Address
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Address Line | 5830 E 2ND ST STE 7000
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City | CASPER
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State | WY
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Zip | 82609-4308
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Country | US
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Telephone | 713-542-8592
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Fax |
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Authorized Official
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Title or Position | PHYSICIAN MEMBER
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Name | KEVIN PAUL ROSENBLATT
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Credential | MD, PHD
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Telephone | 713-542-8592
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207ZP0104X
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Taxonomy Name | Chemical Pathology Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 207ZP0105X
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Taxonomy Name | Clinical Pathology/Laboratory Medicine Physician
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 207ZI0100X
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Taxonomy Name | Immunopathology Physician
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 207ZM0300X
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Taxonomy Name | Medical Microbiology Physician
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License Number |
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License Number State |
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Taxonomy #5
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Taxonomy Code | 207ZC0008X
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Taxonomy Name | Clinical Informatics (Pathology) Physician
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License Number |
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License Number State |
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Taxonomy #6
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Taxonomy Code | 207ZP0007X
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Taxonomy Name | Molecular Genetic Pathology (Pathology) Physician
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License Number |
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License Number State |
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