Healthcare Provider Details

I. General information

NPI: 1497754865
Provider Name (Legal Business Name): PALOS PATHOLOGY ASSOCIATES LTD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/19/2005
Last Update Date: 06/29/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9050 W 81ST ST
JUSTICE IL
60458-1350
US

IV. Provider business mailing address

520 E. 22ND STREET
LOMBARD IL
60148
US

V. Phone/Fax

Practice location:
  • Phone: 708-929-4326
  • Fax:
Mailing address:
  • Phone: 630-874-2542
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207ZP0102X
TaxonomyAnatomic Pathology & Clinical Pathology Physician
License Number
License Number State

VIII. Authorized Official

Name: STEPHEN G. RUBY
Title or Position: CHAIRMAN
Credential: M.D.
Phone: 708-923-4000