Universal Dermatopathology Lab, PLLC

Primary specialty

Clinical Medical LaboratoryTaxonomy code 291U00000X

License

23D2034749 Issued in MI

Legal business name

UNIVERSAL DERMATOPATHOLOGY LAB, PLLC

Practice address

2650 Horizon Dr SE
Suite 233
Grand Rapids, MI 49546-7519

Phone

(616) 419-3607

Fax

(616) 419-3679

NPI assigned

Jan 20, 2012

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Won K Lee, M.D.NPI 1871538124

Title

Director

Phone

(616) 419-3607

Specialties & licenses 1

Addresses

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Won Kyu Lee, MD

  • Dermatopathology (Pathology) Physician
  • Grand Rapids, MI
  • NPI 1871538124
  NPD (past) Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1327017600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1358899200000",
    "number": "1467723502",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2650 HORIZON DR SE",
            "address_2": "SUITE 233",
            "city": "GRAND RAPIDS",
            "state": "MI",
            "postal_code": "495467519",
            "telephone_number": "616-419-3607",
            "fax_number": "616-419-3679"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2650 HORIZON DR SE",
            "address_2": "SUITE 233",
            "city": "GRAND RAPIDS",
            "state": "MI",
            "postal_code": "495467519",
            "telephone_number": "616-419-3607",
            "fax_number": "616-419-3679"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "UNIVERSAL DERMATOPATHOLOGY LAB, PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-01-20",
        "last_updated": "2013-01-23",
        "status": "A",
        "authorized_official_last_name": "LEE",
        "authorized_official_first_name": "WON",
        "authorized_official_middle_name": "K",
        "authorized_official_title_or_position": "DIRECTOR",
        "authorized_official_telephone_number": "616-419-3607",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "291U00000X",
            "taxonomy_group": "",
            "desc": "Clinical Medical Laboratory",
            "state": "MI",
            "license": "23D2034749",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Clinical Medical Laboratory in Grand Rapids, MI
• Providers in Grand Rapids, MI by specialty
• Clinical Medical Laboratory in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 23, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.