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Clinical Pathology/Laboratory Medicine >> Pathology >> Allopathic & Osteopathic Physicians

Registrant NPI Number: 1205988987

Individual Registrant:
Gender: M
Not Sole Proprietor

Location and contact information for practice:
180 HARVESTER DR STE 110  BURR RIDGE, IL 60527-6686 US
Tel: 773-834-4064  Fax: --

Contact information for business:
5841 S MARYLAND AVE # MC1099  CHICAGO, IL 60637-1447 US
Tel: --  Fax: --

Registration Information:
NPI: 1205988987
Entity Type: Individual

Specialty information:

PrimaryCodeCategory/DescriptionStateLicense Number
Y207ZP0105XAllopathic & Osteopathic Physicians
Clinical Pathology/Laboratory Medicine

Legacy codes, insurance codes and state license numbers:



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