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General NPI Number Information
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NPI Number | 1245263797
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Entity Type | Organization
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Legal Business Name | UNIVERSITY PATHOLOGISTS PC
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Dates
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Enumeration Date | 07/08/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 3990 JOHN R ST
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City | DETROIT
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State | MI
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Zip | 48201-2018
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Country | US
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Telephone | 313-745-8555
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Fax |
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Provider Business Mailing Address
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Address Line | 3800 WOODWARD AVE SUITE 702
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City | DETROIT
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State | MI
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Zip | 48201-2061
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | CHAIR
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Name | DAVID GRIGNON
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Credential | M.D.
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Telephone | 313-745-8555
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207ZP0102X
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Taxonomy Name | Anatomic Pathology & Clinical Pathology Physician
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License Number |
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License Number State |
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