Organization
JACKSON PATHOLOGY ASSOCIATES, PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. RICHARD DIETERLE MD (PRESIDENT)
(517) 788-4951
Entity
Organization
Contact information
Practice address
205 N EAST AVE, JACKSON, MI 49201-1753
(517) 788-4951
Mailing address
205 N EAST AVE, JACKSON, MI 49201-1753
(517) 788-4951
Taxonomy
Speciality
Code
Description
License number
State
207ZP0102X
Anatomic Pathology & Clinical Pathology Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
029604
MIDWEST HEALTH PLAN
MI
01
—
0C86006
BLUE CROSS BLUE SHIELD MI
MI
01
—
1006045
INGHAM HEALTH PLAN
MI
01
—
104757
PREFERRED CHOICES
MI
01
—
128395
SELECTCARE
MI
01
—
13484880
US DEPT OF LABOR WORKCOMP
MI
01
—
134848800
FEDERAL BLACK LUNG
MI
01
—
37102
COMMUNITY CHOICE OF MI
MI
01
—
CN1205
RAILROAD MEDICARE
MI
01
—
LP380001
M-CARE
MI
01
—
M011703
UNITED MINE WORKERS
MI
01
—
XX05469
HEALTHPLUS OF MI
MI
Enumeration date
12/15/2006
Last updated
04/20/2008
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