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NPI Code Detail

MEDICARE: LABORATORY MEDICINE CONSULTANTS LTD

MEDICARE: LABORATORY MEDICINE CONSULTANTS LTD
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207ZC0500XCytopathology Physician
2207ZD0900XDermatopathology (Pathology) Physician
3207ZH0000XHematology (Pathology) Physician
4207ZP0213XPediatric Pathology Physician
5207ZP0102XAnatomic Pathology & Clinical Pathology Physician

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1083675169
Entity Type Code : Organization
Provider Name (Legal Business Name) : LABORATORY MEDICINE CONSULTANTS LTD
Provider Business Mailing Address
First Line : 11025 RCA CENTER DR
Second Line : SUITE 300
City : PALM BEACH GARDENS
State : FL
Zip : 33410-4269
Country : US
Telephone Number : 561-626-5512
Fax Number : 561-626-4530
Provider Business Practice Location Address
First Line : 7455 W WASHINGTON AVE
Second Line : SUITE 301
City : LAS VEGAS
State : NV
Zip : 89128-4337
Country : US
Telephone Number : 702-732-3441
Fax Number : 702-732-2310
Authorized Official
Title or Position : VICE PRESIDENT
Name : MICHAEL C. GRATTENDICK
Credential :
Telephone Number : 561-626-5512
Provider Enumeration Date : 03/29/2006
Last Update Date : 03/23/2016

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Directions to “LABORATORY MEDICINE CONSULTANTS LTD ” Practice Location

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