Basic Information
| Provider Information | |||||||||
| NPI: | 1568570471 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | FLINT CLINICAL PATHOLOGIST PC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3490 CALKINS RD | ||||||||
| Address2: | |||||||||
| City: | FLINT | ||||||||
| State: | MI | ||||||||
| PostalCode: | 485323506 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8107337741 | ||||||||
| FaxNumber: | 8107338898 | ||||||||
| Practice Location | |||||||||
| Address1: | 3490 CALKINS RD | ||||||||
| Address2: | |||||||||
| City: | FLINT | ||||||||
| State: | MI | ||||||||
| PostalCode: | 485323506 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8107337741 | ||||||||
| FaxNumber: | 8107338898 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/29/2006 | ||||||||
| LastUpdateDate: | 03/29/2022 | ||||||||
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| AuthorizedOfficialLastName: | ROSELLI | ||||||||
| AuthorizedOfficialFirstName: | CHRYS | ||||||||
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| AuthorizedOfficialTitleorPosition: | BUSINESS MANAGER | ||||||||
| AuthorizedOfficialTelephone: | 8107337741 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| NPICertificationDate: | 03/29/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207ZP0102X | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Pathology | Anatomic Pathology & Clinical Pathology |
ID Information
| ID | Type | State | Issuer | Description | 1568570471 | 05 | MI | MEDICAID |