Organization
INDIANA PATHOLOGY CONSULTANTS, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. MAX L DANIELS (CORPORATE MANAGER)
(260) 432-5867
Entity
Organization
Contact information
Practice address
7950 WEST JEFFERSON BLVD., PATHOLOGY DEPARTMENT, FORT WAYNE, IN 46804
(260) 435-7154
(260) 435-7633
Mailing address
3240B MALLARD COVE LN, FORT WAYNE, IN 46804-2883
(260) 432-5867
(260) 436-9013
Taxonomy
Speciality
Code
Description
License number
State
207ZP0102X
Anatomic Pathology & Clinical Pathology Physician
Primary
50000730A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100053700B
—
IN
01
—
CN1365
RAILROAD
—
Enumeration date
02/21/2007
Last updated
09/28/2009
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