Individual
MIRIAM RENEE CONCES
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
700 CHILDRENS DR, COLUMBUS, OH 43205-2664
(614) 722-5718
Mailing address
DEPT 781676, PO BOX 78000, DETROIT, MI 48278-1676
(614) 722-5315
(614) 722-3033
Taxonomy
Speciality
Code
Description
License number
State
207ZP0102X
Anatomic Pathology & Clinical Pathology Physician
0101258565
VA
207ZP0102X
Anatomic Pathology & Clinical Pathology Physician
35.128409
OH
207ZP0213X
Pediatric Pathology Physician
Primary
35.128409
OH
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0150155
—
OH
01
—
H312740
MEDICARE
OH
Enumeration date
04/19/2011
Last updated
06/30/2016
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