Organization
COMMUNITY PATHOLOGY & NUCLEAR MEDICINE PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
BOGUSLAW I UCHMAN M.D. (PRESIDENT)
(765) 298-5172
Entity
Organization
Contact information
Practice address
1515 N MADISON AVE, ANDERSON, IN 46011-3453
(765) 298-5172
Mailing address
PO BOX 563, ANDERSON, IN 46015-0563
(765) 640-1307
(765) 640-1376
Taxonomy
Speciality
Code
Description
License number
State
207ZP0102X
Anatomic Pathology & Clinical Pathology Physician
Primary
01027944A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000103808
BLUE SHEILD
IN
05
—
100173020A
—
IN
Enumeration date
06/15/2005
Last updated
03/10/2014
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