MEDICARE: CUTANEOUS AND MAXILLOFACIAL PATHOLOGY LABORATORY, PC

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
1	291U00000X	Clinical Medical Laboratory
2	291U00000X	Clinical Medical Laboratory	15D0647261	IN

Other Identifiers

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

General Provider Information

NPI Number	:	1386717940
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CUTANEOUS AND MAXILLOFACIAL PATHOLOGY LABORATORY, PC

Provider Business Mailing Address
First Line	:	9292 N. MERIDIAN ST.
Second Line	:	SUITE 210
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46260-1828
Country	:	US
Telephone Number	:	317-843-2204
Fax Number	:	317-843-2478

Provider Business Practice Location Address
First Line	:	9292 N. MERIDIAN ST.
Second Line	:	SUITE 210
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46260-1828
Country	:	US
Telephone Number	:	317-843-2204
Fax Number	:	317-843-2478

Authorized Official
Title or Position	:	BILLING CLERK
Name	:	CHRISTY D. LYNN
Credential	:
Telephone Number	:	317-843-2204

Provider Enumeration Date	:	11/15/2006
Last Update Date	:	06/10/2019

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