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Organization
KENOSHA PATHOLOGY CONSULTANTS
Active
Organization
KENOSHA PATHOLOGY CONSULTANTS
Active
Organization subpart
No
Provider details
NPI number
Authorized official
SUSAN K COOPER (MANAGER)
(262) 656-2718
Entity
Organization
Contact information
Practice address
6308 8TH AVE, KENOSHA, WI 53143-5031
(262) 656-3063
(262) 656-2749
Mailing address
PO BOX 130, KENOSHA, WI 53141-0130
(262) 656-3063
(262) 656-2749
Taxonomy
Speciality
Code
Description
License number
State
207ZP0102X
Anatomic Pathology & Clinical Pathology Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
32873400
—
WI
Enumeration date
02/27/2007
Last updated
03/06/2008
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