=====================================================
General NPI Number Information
=====================================================
NPI Number | 1316192248
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | COMMUNITY PATHOLOGY ASSOCIATES, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/19/2008
-----------------------------------------------------
Last Update Date | 03/07/2012
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2701 W 68TH ST
-----------------------------------------------------
City | CHICAGO
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60629-1813
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 877-852-4669
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 5957
-----------------------------------------------------
City | CAROL STREAM
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60197-5957
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 877-852-4669
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | ADIL ZARIF
-----------------------------------------------------
Credential | M.D.
-----------------------------------------------------
Telephone | 773-884-4632
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207ZP0102X
-----------------------------------------------------
Taxonomy Name | Anatomic Pathology & Clinical Pathology Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State | IL
-----------------------------------------------------