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General NPI Number Information
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NPI Number | 1174762256
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Entity Type | Organization
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Legal Business Name | CONSOLIDATED PATHOLOGY CONSULTANTS, SC
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Dates
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Enumeration Date | 02/12/2009
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Last Update Date | 01/04/2024
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Provider Practice Location Address
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Address Line | 28100 N ASHLEY CIR SUITE 106
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City | LIBERTYVILLE
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State | IL
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Zip | 60048-9478
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Country | US
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Telephone | 847-996-1030
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Fax |
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Provider Business Mailing Address
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Address Line | 75 REMITTANCE DR SUITE 1895
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City | CHICAGO
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State | IL
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Zip | 60675-1001
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Country | US
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Telephone | 847-535-6215
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Fax |
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Authorized Official
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Title or Position | LAB DIRECTOR
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Name | TRACY KNOX
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Credential |
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Telephone | 847-996-1030
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 291U00000X
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Taxonomy Name | Clinical Medical Laboratory
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License Number | 14D1094992
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 207ZP0105X
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Taxonomy Name | Clinical Pathology/Laboratory Medicine Physician
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License Number |
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License Number State |
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