Basic Information
| Provider Information | |||||||||
| NPI: | 1558491134 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | PATHOLOGY ASSOCIATES OF NORTHERN ILLINOIS, PC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5918 PARTRIDGE LN | ||||||||
| Address2: | |||||||||
| City: | LONG GROVE | ||||||||
| State: | IL | ||||||||
| PostalCode: | 600475056 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8476341922 | ||||||||
| FaxNumber: | 7084860080 | ||||||||
| Practice Location | |||||||||
| Address1: | 2225 ENTERPRISE DR | ||||||||
| Address2: | SUITE 2511 | ||||||||
| City: | WESTCHESTER | ||||||||
| State: | IL | ||||||||
| PostalCode: | 601545814 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7084860076 | ||||||||
| FaxNumber: | 7084860080 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/06/2007 | ||||||||
| LastUpdateDate: | 08/22/2020 | ||||||||
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| AuthorizedOfficialLastName: | RAFF | ||||||||
| AuthorizedOfficialFirstName: | LESTER | ||||||||
| AuthorizedOfficialMiddleName: | J | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 8476341922 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | M.D. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207ZP0102X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Pathology | Anatomic Pathology & Clinical Pathology |
No ID Information.