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Organization

EAST CENTRAL INDIANA PATHOLOGISTS PC

Active
Organization subpart
No

Provider details

NPI number
Authorized official
GEORGE E BRANAM M.D. (CEO)
(765) 747-3428
Entity
Organization

Contact information

Practice address
2401 W UNIVERSITY AVE, MUNCIE, IN 47303-3428
(765) 741-3428
(765) 741-2905
Mailing address
2401 W UNIVERSITY AVE, MUNCIE, IN 47303-3428
(765) 741-3428
(765) 741-2905

Taxonomy

Speciality
Code
Description
License number
State
207ZC0500X
Cytopathology Physician
01046076A
IN
207ZH0000X
Hematology (Pathology) Physician
01018004A
IN
207ZP0102X
Anatomic Pathology & Clinical Pathology Physician
Primary
01018004A
IN

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
000000101392
BLUE SHIELD GROUP
05
2099554
OH
Enumeration date
10/24/2006
Last updated
12/17/2007
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