Provider Demographics
NPI:1730511346
Name:DIRECT PATH SERVICES, P.C.
Entity type:Organization
Organization Name:DIRECT PATH SERVICES, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/LABORATORY DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:J
Authorized Official - Last Name:SCHWIMER
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:248-220-4425
Mailing Address - Street 1:30200 TELEGRAPH RD
Mailing Address - Street 2:SUITE 405
Mailing Address - City:BINGHAM FARMS
Mailing Address - State:MI
Mailing Address - Zip Code:48025-4502
Mailing Address - Country:US
Mailing Address - Phone:248-220-4425
Mailing Address - Fax:248-220-4428
Practice Address - Street 1:30200 TELEGRAPH RD
Practice Address - Street 2:SUITE 405
Practice Address - City:BINGHAM FARMS
Practice Address - State:MI
Practice Address - Zip Code:48025-4502
Practice Address - Country:US
Practice Address - Phone:248-220-4425
Practice Address - Fax:248-220-4428
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-08-06
Last Update Date:2013-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5101015559291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1730511346Medicaid
MI0H70792OtherBLUE CROSS BLUE SHEILD
MI1730511346Medicaid