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 | 246Q00000X | Specialist/Technologist, Pathology | | 4301051173 MD | MICHIGAN | No |
| 2 | 246QB0000X | Specialist/Technologist, Pathology | Blood Banking | 4301051173 | MICHIGAN | No |
| 3 | 246QC2700X | Specialist/Technologist, Pathology | Cytotechnology | CLM089 | CALIFORNIA | No |
| 4 | 246QH0600X | Specialist/Technologist, Pathology | Histology | 4301051173 MD | MICHIGAN | No |
| 5 | 246RM2200X | Technician, Pathology | Medical Laboratory | 4301051173 MD | MICHIGAN | No |
| 6 | 246QC2700X | Specialist/Technologist, Pathology | Cytotechnology | | MICHIGAN | No |
| 7 | 246QH0600X | Specialist/Technologist, Pathology | Histology | | MICHIGAN | No |
| 8 | 246QL0900X | Specialist/Technologist, Pathology | Laboratory Management | | MICHIGAN | No |
| 9 | 246R00000X | Technician, Pathology | | | MICHIGAN | No |
| 10 | 246RM2200X | Technician, Pathology | Medical Laboratory | | MICHIGAN | 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 | 162381523463 | OTHER | MICHIGAN | HUMMANA |
| 2 | ========= | OTHER | MICHIGAN | MOLINA HEALTHCARE OF MICH |
| 3 | 71020000E1 1500 | OTHER | MICHIGAN | BCBS OF MICH FEDERAL |
| 4 | 0N4330 | MEDICARE ID-TYPE UNSPECIFIED | MICHIGAN | |
| 5 | 0========= | OTHER | MICHIGAN | ASSURANT HEALTH |
| 6 | =========-A01 | OTHER | MICHIGAN | MEDICAL MUTUAL |
| 7 | ========= | OTHER | MICHIGAN | PRIORITY HEALTH |
| 8 | ========= | OTHER | MICHIGAN | COMMUNITY CHOICE |
| 9 | 303702 | OTHER | MICHIGAN | TENCON |
