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NPI Code Detail

MEDICARE: PALOS PATHOLOGY ASSOCIATES LTD

MEDICARE: PALOS PATHOLOGY ASSOCIATES LTD
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207ZP0102XAnatomic Pathology & Clinical Pathology Physician

General Provider Information

NPI Number : 1497754865
Entity Type Code : Organization
Provider Name (Legal Business Name) : PALOS PATHOLOGY ASSOCIATES LTD
Provider Business Mailing Address
First Line : 520 E. 22ND STREET
Second Line :
City : LOMBARD
State : IL
Zip : 60148
Country : US
Telephone Number : 630-874-2542
Fax Number :
Provider Business Practice Location Address
First Line : 9050 W 81ST ST
Second Line :
City : JUSTICE
State : IL
Zip : 60458-1350
Country : US
Telephone Number : 708-929-4326
Fax Number :
Authorized Official
Title or Position : CHAIRMAN
Name : STEPHEN G. RUBY
Credential : M.D.
Telephone Number : 708-923-4000
Provider Enumeration Date : 07/19/2005
Last Update Date : 06/29/2009

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Directions to “PALOS PATHOLOGY ASSOCIATES LTD ” Practice Location

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