Healthcare Provider Details

I. General information

NPI: 1487736252
Provider Name (Legal Business Name): SME PATHOLOGISTS SC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/20/2006
Last Update Date: 07/24/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2233 W DIVISION ST
CHICAGO IL
60622-3043
US

IV. Provider business mailing address

PO BOX 3133
INDIANAPOLIS IN
46206-3133
US

V. Phone/Fax

Practice location:
  • Phone: 815-756-1521
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207ZC0500X
TaxonomyCytopathology Physician
License Number
License Number State

VIII. Authorized Official

Name: SAGUL TONSIENGSOM
Title or Position: PRESIDENT
Credential:
Phone: 630-202-3134