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General NPI Number Information
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NPI Number | 1013012939
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Entity Type | Organization
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Legal Business Name | PATHOLOGY SERVICES ILLINOIS, LTD
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Dates
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Enumeration Date | 09/14/2006
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Last Update Date | 10/15/2019
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Provider Practice Location Address
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Address Line | 2875 W 19TH ST
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City | CHICAGO
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State | IL
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Zip | 60623-3501
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Country | US
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Telephone | 773-484-1000
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 1287
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City | INDIANAPOLIS
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State | IN
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Zip | 46206-1287
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DILIPKUMAR DHARKAR
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Credential | M.D.
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Telephone | 773-484-4135
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207ZP0102X
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Taxonomy Name | Anatomic Pathology & Clinical Pathology Physician
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License Number |
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License Number State |
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