Organization
WEST SUBURBAN PATHOLOGY CONSULTANTS PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. MATTHEW DALY MCCOY MD (SECRETARY/TREASURER)
(952) 993-5290
Entity
Organization
Contact information
Practice address
6500 EXCELSIOR BLVD, MINNEAPOLIS, MN 55426-4702
(952) 993-5290
Mailing address
PO BOX 385760, BLOOMINGTON, MN 55438-5760
(952) 944-0970
Taxonomy
Speciality
Code
Description
License number
State
207ZP0102X
Anatomic Pathology & Clinical Pathology Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
18722WE
BLUE SHIELD
MN
Enumeration date
03/21/2006
Last updated
09/12/2007
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