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General NPI Number Information
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NPI Number | 1982660734
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Entity Type | Organization
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Legal Business Name | KENT PATHOLOGY LABORATORY PLLC
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Dates
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Enumeration Date | 04/21/2006
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Last Update Date | 06/17/2010
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Provider Practice Location Address
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Address Line | 2650 HORIZON DR SE SUITE B
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City | GRAND RAPIDS
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State | MI
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Zip | 49546-7519
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Country | US
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Telephone | 616-458-1255
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Fax | 616-458-1292
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Provider Business Mailing Address
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Address Line | 2650 HORIZON DR SE SUITE B
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City | GRAND RAPIDS
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State | MI
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Zip | 49546-7519
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Country | US
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Telephone | 616-458-1255
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Fax | 616-458-1292
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Authorized Official
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Title or Position | DIRECTOR
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Name | DR. JOHN C PUI
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Credential | M.D.
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Telephone | 616-458-1255
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 291U00000X
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Taxonomy Name | Clinical Medical Laboratory
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License Number | CLIA 23D0714247
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License Number State | MI
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