Healthcare Provider Details

I. General information

NPI: 1780070466
Provider Name (Legal Business Name): PATHFINDER MEDICAL GROUP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/09/2015
Last Update Date: 05/11/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

301 MCCULLOUGH DR SUITE 400
CHARLOTTE NC
28262-3310
US

IV. Provider business mailing address

272 E DEERPATH SUITE 204
LAKE FOREST IL
60045-5314
US

V. Phone/Fax

Practice location:
  • Phone: 847-915-6389
  • Fax:
Mailing address:
  • Phone: 847-915-6389
  • Fax: 847-686-2020

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2083P0901X
TaxonomyPublic Health & General Preventive Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: NATASHA KUHNS
Title or Position: BILLING MANAGER
Credential:
Phone: 847-915-6389