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General NPI Number Information
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NPI Number | 1376866897
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Entity Type | Organization
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Legal Business Name | PHYSICIANS DERMPATH LABORATORY
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Dates
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Enumeration Date | 03/11/2010
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Last Update Date | 11/09/2010
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Provider Practice Location Address
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Address Line | 1420 N. RENAISSANCE DR. SUITE 204
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City | PARK RIDGE
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State | IL
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Zip | 60068-1330
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Country | US
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Telephone | 847-768-2440
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Fax | 847-768-2443
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Provider Business Mailing Address
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Address Line | 1420 N. RENAISSANCE DR. SUITE 204
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City | PARK RIDGE
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State | IL
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Zip | 60068-1330
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Country | US
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Telephone | 847-768-2440
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Fax | 847-768-2443
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. DAVID A. LORBER
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Credential | MD
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Telephone | 847-675-9711
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207ND0900X
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Taxonomy Name | Dermatopathology Physician
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License Number |
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License Number State |
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