Organization
DERMATOPATHOLOGY OF WISCONSIN SC
Active
Parent organization
AMERIPATH INC.
Other names
Dermpath Diagnostics of WI
Organization subpart
Yes
Provider details
NPI number
Legal business name
AMERIPATH INC.
Authorized official
DARREN THOMAS WHEELER MD (VICE PRESIDENT)
(702) 733-7866
Entity
Organization
Contact information
Practice address
12805 W BURLEIGH RD, SUITE 200, BROOKFIELD, WI 53005-3111
(262) 797-6434
(262) 797-6429
Mailing address
14275 MIDWAY RD STE 400, ADDISON, TX 75001-3661
(214) 932-8018
(610) 271-4245
Taxonomy
Speciality
Code
Description
License number
State
291U00000X
Clinical Medical Laboratory
Primary
52D0661946
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0765271
—
IA
05
—
1164494142
—
MI
05
—
14900
—
ND
05
—
32911800
—
WI
01
—
52D1105706
CLIA
WI
05
—
5585170
—
SD
05
—
749475100
—
MN
Enumeration date
02/03/2006
Last updated
09/20/2024
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