Provider Demographics
NPI:1699707067
Name:BSC PATHOLOGY ASSOCIATES PC
Entity type:Organization
Organization Name:BSC PATHOLOGY ASSOCIATES PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:SURESH
Authorized Official - Middle Name:K
Authorized Official - Last Name:GEHANI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:313-343-1615
Mailing Address - Street 1:PO BOX 77000
Mailing Address - Street 2:DEPT 77263
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48277-0263
Mailing Address - Country:US
Mailing Address - Phone:313-343-1615
Mailing Address - Fax:313-343-1803
Practice Address - Street 1:468 CADIEUX ROAD
Practice Address - Street 2:
Practice Address - City:GROSSE POINTE
Practice Address - State:MI
Practice Address - Zip Code:48230-1507
Practice Address - Country:US
Practice Address - Phone:313-343-1615
Practice Address - Fax:313-343-1803
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-07
Last Update Date:2007-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical PathologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0M88330Medicare PIN