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General NPI Number Information
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NPI Number | 1720118714
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Entity Type | Organization
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Legal Business Name | LAKELAND PATHOLOGY
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Dates
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Enumeration Date | 03/07/2007
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Last Update Date | 10/20/2010
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Provider Practice Location Address
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Address Line | 750 E 34TH ST
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City | HIBBING
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State | MN
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Zip | 55746-2341
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Country | US
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Telephone | 218-312-3002
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Fax | 218-312-3003
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Provider Business Mailing Address
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Address Line | 1200 E 25TH STREET
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City | HIBBING
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State | MN
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Zip | 55746-2341
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Country | US
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Telephone | 218-312-3002
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Fax | 218-312-3003
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Authorized Official
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Title or Position | OWNER
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Name | THOMAS UNCINI
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Credential | M.D.
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Telephone | 218-312-3002
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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 | 29005
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License Number State | MN
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