HERITAGE LABS, INC. (NPI# 1790274678) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1790274678 |
| Entity Type | Organization |
| Organization Name | HERITAGE LABS, INC. |
| Other Organization Name | HERITAGE LABORATORIES |
| Practice Address |
2891 E Maple Rd Troy MI 48083-6106 |
| Mailing Address |
1835 Ashbourne Dr Canton MI 48187-5907 |
| Practice Telephone | 7349682174 |
| Practice Fax Number | 2486099054 |
| Mailing Telephone | 7349682174 |
| Mailing Fax Number | 2486099054 |
| Enumeration Date | 2018-05-06 |
| Last Update Date | 2018-05-06 |
| Authorized Official Name | MRS. DIPTIBAHEN N PATEL (PRESIDENT) |
| Authorized Official Telephone | 7349682174 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 207ZP0105X |
Pathology Specialization: Clinical Pathology/Laboratory Medicine |
Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| CLIA IDENTIFICATION NUMBER | 23D2147454 | 01 |
| Other Name | Type Code |
|---|---|
| HERITAGE LABORATORIES | Doing Business As Name - Organization |
| Street Address |
2891 E MAPLE RD |
| City | TROY |
| State | MI |
| Zip Code | 48083-6106 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1174507768 | Hanna J Obertynski | Ophthalmology | 2891 E Maple Rd, Suite 200, Troy, MI 48083-6106 | 2005-12-06 |
| 1124426911 | Oksana Trotska | Nurse Practitioner | 2891 E Maple Rd, Troy, MI 48083-6106 | 2014-12-11 |
| 1861793432 | Heritage Rehabilitation Center | Physical Therapist | 2891 E Maple Rd, Suite 103, Troy, MI 48083-6106 | 2010-11-12 |
| 1811162928 | Hanna Obertynski M D P C | Specialist | 2891 E Maple Rd, Ste#200, Troy, MI 48083-6106 | 2008-04-29 |
| 1528123304 | Heritage Physical Therapy, Pllc | Clinic/Center | 2891 E Maple Rd, Ste 103, Troy, MI 48083-6106 | 2006-12-22 |
| 1730248204 | Antoni Lodzinski | Physical Therapist | 2891 E Maple Rd, Troy, MI 48083-6106 | 2006-12-08 |
| 1447280227 | Alicja Bernarda Nerga | Family Medicine | 2891 E Maple Rd, Suite 102, Troy, MI 48083-6106 | 2006-07-04 |
| 1417993924 | Troy Professional Pharmacy Inc | Pharmacy | 2891 E Maple Rd, Ste 105, Troy, MI 48083-6106 | 2006-06-22 |
| 1740223239 | Metro Medical Practice PC | Obstetrics & Gynecology | 2891 E Maple Rd, Suite 102, Troy, MI 48083-6106 | 2006-06-13 |
| 1447290275 | Stanislaw Jaszczak | Obstetrics & Gynecology | 2891 E Maple Rd, Suite 102, Troy, MI 48083-6106 | 2006-06-08 |
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| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1417420449 | Thapasvi Muttirevula | Physical Therapist | 2422 Cedar Knoll Dr, Troy, MI 48083 | 2019-01-02 |
| 1114418290 | Ann Katchke | Physical Therapist | 3179 Livernois Rd, Troy, MI 48083 | 2018-05-23 |
| 1518485945 | Risa Rae Mendelson | Counselor | 1059 Owendale Street, Troy, MI 48083 | 2017-09-06 |
| 1497277115 | Gassan Asadi | Pharmacist | 215 E Big Beaver Rd Ste 500, Troy, MI 48083 | 2017-07-14 |
| 1528510328 | Dylan Skye Polasko | Behavioral Analyst | 2221 E 4th St, #101, Troy, MI 48083 | 2016-10-27 |
| 1235683061 | Sadia Ghazi | Technician, Other | 3178 Daley Dr., Troy, MI 48083 | 2016-08-10 |
| 1548664345 | Amber Leigh Ernst | Social Worker | 1225 E. Big Beaver Road, Troy, MI 48083 | 2014-10-22 |
| 1356782411 | Michelle Louise Knoblock | Nurse Anesthetist, Certified Registered | 1560 E Maple Rd Ste 100, Troy, MI 48083 | 2013-07-17 |
| 1437400728 | Oakland Physicians Surgery Center | Clinic/Center | 1560 E. Maple Road, Suite 100, Troy, MI 48083 | 2012-09-26 |
| 1861748238 | Pro Med Substance Abuse Program LLC | Psychologist | 2891 E. Maple Rd. Suite 200, Troy, MI 48083 | 2012-08-03 |
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| Taxonomy Code | 207ZP0105X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Pathology |
| Specialization | Clinical Pathology/Laboratory Medicine |
| A pathologist deals with the causes and nature of disease and contributes to diagnosis, prognosis and treatment through knowledge gained by the laboratory application of the biologic, chemical and physical sciences. A pathologist uses information gathered from the microscopic examination of tissue specimens, cells and body fluids, and from clinical laboratory tests on body fluids and secretions for the diagnosis, exclusion and monitoring of disease. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: definiton added, source added; 7/1/2011: modified source] - Additional Resources: American Board of Pathology, 2007. http://www.abpath.org/. American Osteopathic Board of Pathology, 2007. http://www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Pathology. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Pathology. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1730358854 | William Alexander Block | Pathology | 500 Kirts Blvd, Troy, MI 48084-4134 | 2008-02-22 |
| 1407928542 | Suseelamm R Kandula | Pathology | 3130 N County Road 25a, Troy, OH 45373-1337 | 2006-11-14 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1033748728 | Steve Martin | Pathology | 5575 Conner St Ste A, Detroit, MI 48213-6400 | 2020-04-04 |
| 1083020150 | Maria Vida Villegas Singson | Pathology | 30946 Roselawn Dr, Warren, MI 48088-5948 | 2014-07-09 |
| 1205264579 | Visiting Nurse Services of Michigan | Pathology | 4000 S Saginaw St, Flint, MI 48507-2604 | 2013-10-24 |
| 1982996831 | Yasin K Ahmed | Pathology | 919 Shore Club Dr, Saint Clair Shores, MI 48080-1562 | 2011-05-11 |
| 1215102272 | Aspirus Iron River Hospital & Clinics, Inc. | Pathology | 1400 West Ice Lake Road, Iron River, MI 49935 | 2008-04-29 |
| 1437205200 | Shirley Siew | Pathology | A622 E Fee Hall, East Lansing, MI 48824 | 2007-01-26 |
| 1558443432 | Thomas E Wilson | Pathology | 1500 East Medical Center, 2nd Floor University Hospital Recp Pathology, Ann Arbor, MI 48109-5054 | 2006-10-19 |
| 1013424399 | Tox Testing Inc | Pathology | 16100 19 Mile Rd Ste 200, Clinton Township, MI 48038-1148 | 2018-01-08 |
| 1265835110 | Ghassan Allo | Pathology | 2799 W Grand Blvd, Henry Ford Hospital, Dept of Pathology K-6, Detroit, MI 48202-2608 | 2014-10-07 |
| 1245639475 | Lee F Schroeder | Pathology | 1500 E Medical Center Dr, Ann Arbor, MI 48109-5000 | 2014-08-13 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.