Organization
WESTERN PATHOLOGY CONSULTANTS, LTD
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MICHAEL GRATTENDICK (VICE PRESIDENT)
(775) 746-3400
Entity
Organization
Contact information
Practice address
343 ELM ST, SUITE 206, RENO, NV 89503-4522
(775) 746-3400
(775) 746-3411
Mailing address
11025 RCA CENTER DR, SUITE 300, PALM BEACH GARDENS, FL 33410-4269
(561) 626-5512
(561) 626-4530
Taxonomy
Speciality
Code
Description
License number
State
207ZP0105X
Clinical Pathology/Laboratory Medicine Physician
Primary
NV1512LIC-5
NV
291U00000X
Clinical Medical Laboratory
NV1512LIC-5
NV
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
201672000
—
NV
01
—
XXGG007750
MEDICAL
NV
Enumeration date
06/09/2005
Last updated
08/26/2022
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