MEDICARE: MICHIGAN PATHOLOGY ASSOCIATES, 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	207ZP0102X	Anatomic Pathology & Clinical Pathology Physician

General Provider Information

NPI Number	:	1639156789
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MICHIGAN PATHOLOGY ASSOCIATES, PC

Provider Business Mailing Address
First Line	:	PO BOX 77000
Second Line	:
City	:	DETROIT
State	:	MI
Zip	:	48277-2000
Country	:	US
Telephone Number	:	800-678-1861
Fax Number	:

Provider Business Practice Location Address
First Line	:	2333 BIDDLE ST
Second Line	:
City	:	WYANDOTTE
State	:	MI
Zip	:	48192-4668
Country	:	US
Telephone Number	:	734-246-6922
Fax Number	:

Authorized Official
Title or Position	:	CREDENTIALER
Name	:	DR. AARON LUPOVITCH
Credential	:	MD
Telephone Number	:	419-866-1804

Provider Enumeration Date	:	12/29/2005
Last Update Date	:	07/16/2007

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