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General NPI Number Information
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NPI Number | 1619205390
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Entity Type | Organization
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Legal Business Name | DAVID RESEN PATHOLOGY SERVICES S C
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Dates
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Enumeration Date | 11/18/2009
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Last Update Date | 10/28/2015
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Provider Practice Location Address
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Address Line | 8619 EDGEWATER RDG
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City | OMRO
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State | WI
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Zip | 54963-9760
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Country | US
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Telephone | 920-376-1255
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Fax |
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Provider Business Mailing Address
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Address Line | 8619 EDGEWATER RDG
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City | OMRO
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State | WI
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Zip | 54963-9760
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Country | US
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Telephone | 920-376-1255
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Fax |
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Authorized Official
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Title or Position | VICE PRESIDENT
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Name | MARIBETH RESEN
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Credential |
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Telephone | 920-376-1255
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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 | 32951
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License Number State | WI
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