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General NPI Number Information
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NPI Number | 1255724100
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Entity Type | Organization
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Legal Business Name | WEST MICHIGAN PATHOLOGY SPECIALISTS, PC
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Dates
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Enumeration Date | 03/16/2015
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Last Update Date | 05/13/2015
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Provider Practice Location Address
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Address Line | 1521 GULL RD
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City | KALAMAZOO
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State | MI
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Zip | 49048-1640
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Country | US
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Telephone | 269-266-5917
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Fax | 419-866-5453
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Provider Business Mailing Address
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Address Line | 5700 SOUTHWYCK BLVD
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City | TOLEDO
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State | OH
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Zip | 43614-1509
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Country | US
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Telephone | 800-288-8325
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Fax | 419-866-5453
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Authorized Official
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Title or Position | AUTHORIZED SIGNER
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Name | DR. MARK B AUSTIN
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Credential | MD
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Telephone | 269-266-5917
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207ND0900X
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Taxonomy Name | Dermatopathology Physician
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License Number |
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License Number State |
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