NPIMap

Organization Active NPI

Michigan Diagnostic Pathologists, PLLC

  • Anatomic Pathology & Clinical Pathology Physician
  • Southfield, MI
National Provider Identifier
1578734281
Registry record updated Feb 19, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Anatomic Pathology & Clinical Pathology PhysicianTaxonomy code 207ZP0102X
Legal business name
MICHIGAN DIAGNOSTIC PATHOLOGISTS, PLLC
Practice address
16001 W 9 Mile Rd
Providence Hospital, Department of Pathology
Southfield, MI 48075-4818
Phone
(248) 849-5401
NPI assigned
Mar 20, 2008
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 19, 2025

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

Authorized official

Name
Juanita Evans, MDNPI 1619188141
Title
President
Phone
(248) 849-3000

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 8

Specialty (taxonomy)CodeLicenseStatePrimary
Blood Banking & Transfusion Medicine PhysicianGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 207ZB0001X
Cytopathology PhysicianGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 207ZC0500X
Dermatopathology (Pathology) PhysicianGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 207ZD0900X
Hematology (Pathology) PhysicianGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 207ZH0000X
Immunopathology PhysicianGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 207ZI0100X
Medical Microbiology PhysicianGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 207ZM0300X
Anatomic Pathology & Clinical Pathology PhysicianGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 207ZP0102X Primary
Clinical Pathology/Laboratory Medicine PhysicianGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 207ZP0105X

Addresses

Primary practice location

16001 W 9 Mile Rd
Providence Hospital, Department of Pathology
Southfield, MI 48075-4818

Mailing address

5700 Southwyck Blvd
Toledo, OH 43614-1509

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MI

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20080801000275 MI Part B Supplier - Clinic/Group Practice 9739253279 Receives reassigned benefits from 16 practitioners
Practice locations: Southfield, MI; Garden City, MI; Novi, MI; Rochester, MI

National Provider Directory

National Provider Directory

Locations

24469 Indoplex Cir
Farmington Hills, MI 48335
Phone (248) 426-9800

Practitioners & affiliated clinicians

Practitioners 17

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

View all 17

NPI Registry JSON

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

{
    "created_epoch": "1205971200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1739923200000",
    "number": "1578734281",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5700 SOUTHWYCK BLVD",
            "city": "TOLEDO",
            "state": "OH",
            "postal_code": "436141509"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "16001 W 9 MILE RD",
            "address_2": "PROVIDENCE HOSPITAL, DEPARTMENT OF PATHOLOGY",
            "city": "SOUTHFIELD",
            "state": "MI",
            "postal_code": "480754818",
            "telephone_number": "248-849-5401"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MICHIGAN DIAGNOSTIC PATHOLOGISTS, PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-03-20",
        "last_updated": "2025-02-19",
        "certification_date": "2025-02-19",
        "status": "A",
        "authorized_official_last_name": "EVANS",
        "authorized_official_first_name": "JUANITA",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "248-849-3000",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207ZB0001X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Pathology, Blood Banking & Transfusion Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207ZC0500X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Pathology, Cytopathology",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207ZD0900X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Pathology, Dermatopathology",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207ZH0000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Pathology, Hematology",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207ZI0100X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Pathology, Immunopathology",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207ZM0300X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Pathology, Medical Microbiology",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207ZP0102X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Pathology, Anatomic Pathology & Clinical Pathology",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "207ZP0105X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Pathology, Clinical Pathology/Laboratory Medicine",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Southfield, MI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 19, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.