Healthcare Provider Details

I. General information

NPI: 1457519969
Provider Name (Legal Business Name): CONSULTANTS IN PATHOLOGY SC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/30/2008
Last Update Date: 05/30/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

555 W COURT ST SUITE 300
KANKAKEE IL
60901-3664
US

IV. Provider business mailing address

PO BOX 30309
CHARLESTON SC
29417-0309
US

V. Phone/Fax

Practice location:
  • Phone: 815-937-2194
  • Fax:
Mailing address:
  • Phone: 843-554-9300
  • Fax: 843-566-8780

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: DR. MARK A FRITSCH
Title or Position: PRESIDENT
Credential: MD
Phone: 219-879-2208