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Organization
FOND DU LAC PATHOLOGY CONSULTANTS
Active
Organization
FOND DU LAC PATHOLOGY CONSULTANTS
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JONATHAN GEDYE MD (PRESIDENT)
(920) 926-5800
Entity
Organization
Contact information
Practice address
430 E DIVISION ST, ST AGNES HOSP, PATHOLOGY DEPT, FOND DU LAC, WI 54935-4560
(920) 926-5840
(920) 929-0647
Mailing address
PO BOX 107, FOND DU LAC, WI 54936-0107
(920) 929-9300
(920) 923-5260
Taxonomy
Speciality
Code
Description
License number
State
207ZP0102X
Anatomic Pathology & Clinical Pathology Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
31770700
—
WI
01
—
CO1718
RR MEDICARE
WI
Enumeration date
10/26/2006
Last updated
01/09/2014
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