Taxonomy Codes
The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:
| No. |
Taxonomy Code |
Taxonomy Clasification |
Taxonomy Specialization |
License Number |
License State |
Primary |
| 1 | 207SM0001X | Medical Genetics | Molecular Genetic Pathology | A82079 | CALIFORNIA | No |
| 2 | 207ZP0007X | Pathology | Molecular Genetic Pathology | 2006023097 | MISSOURI | No |
| 3 | 207ZP0007X | Pathology | Molecular Genetic Pathology | 4301081249 | MICHIGAN | No |
| 4 | 207ZP0105X | Pathology | Clinical Pathology/Laboratory Medicine | 2006023097 | MISSOURI | No |
| 5 | 207ZP0105X | Pathology | Clinical Pathology/Laboratory Medicine | 4301081249 | MICHIGAN | No |
| 6 | 207ZP0105X | Pathology | Clinical Pathology/Laboratory Medicine | A82079 | CALIFORNIA | Yes |
Other Identifiers
The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.
| No. |
Other Provider Identifier |
Other Provider Identifier Type |
Other Provider Identifier State |
Other Provider Identifier Issuer |
| 1 | H18399 | MEDICARE UPIN | MISSOURI | |
| 2 | # PENDING | MEDICAID | MISSOURI | |
| 3 | H18399 | MEDICARE UPIN | MICHIGAN | |
| 4 | # PENDING | MEDICARE ID-TYPE UNSPECIFIED | MISSOURI | MEDICARE PROV. # |
| 5 | 0H16101084 | MEDICARE ID-TYPE UNSPECIFIED | MICHIGAN | |
| 6 | 4544083 | MEDICAID | MICHIGAN | |
