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General NPI Number Information
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NPI Number | 1588649024
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Entity Type | Organization
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Legal Business Name | SOUTHERN ILLINOIS PATHOLOGY, PC
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Dates
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Enumeration Date | 12/07/2005
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Last Update Date | 03/14/2011
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Provider Practice Location Address
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Address Line | 404 W MAIN ST PATHOLOGY DEPARTMENT
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City | CARBONDALE
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State | IL
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Zip | 62901-2904
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Country | US
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Telephone | 618-549-0721
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Fax |
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Provider Business Mailing Address
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Address Line | 231 W MAIN ST STE BW ATTN: LISA BROWER
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City | CARBONDALE
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State | IL
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Zip | 62901-2948
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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 | DR. CHANDRASHEKAR PADMALATHA
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Credential | M.D.
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Telephone | 618-549-0721
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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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