MEDICARE: LAKE MCHENRY 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
1	207ZP0102X	Anatomic Pathology & Clinical Pathology Physician

General Provider Information

NPI Number	:	1750380101
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LAKE MCHENRY PATHOLOGY ASSOCIATES LTD

Provider Business Mailing Address
First Line	:	520 E 22ND ST
Second Line	:
City	:	LOMBARD
State	:	IL
Zip	:	60148-6110
Country	:	US
Telephone Number	:	630-874-2542
Fax Number	:

Provider Business Practice Location Address
First Line	:	3701 DOTY RD
Second Line	:
City	:	WOODSTOCK
State	:	IL
Zip	:	60098-7509
Country	:	US
Telephone Number	:	815-338-2500
Fax Number	:

Authorized Official
Title or Position	:	CHAIRMAN
Name	:	NABIL O ALI
Credential	:	M.D.
Telephone Number	:	815-338-2500

Provider Enumeration Date	:	07/19/2005
Last Update Date	:	11/26/2007

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