Provider Demographics
NPI:1114954401
Name:WEST SIDE PATHOLOGY ASSOCIATES, P.C.
Entity Type:Organization
Organization Name:WEST SIDE PATHOLOGY ASSOCIATES, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:POLINA
Authorized Official - Middle Name:
Authorized Official - Last Name:ZAYTSEV
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:877-852-4669
Mailing Address - Street 1:PO BOX 87165
Mailing Address - Street 2:DEPT 2050
Mailing Address - City:CAROL STREAM
Mailing Address - State:IL
Mailing Address - Zip Code:60188-7165
Mailing Address - Country:US
Mailing Address - Phone:877-852-4669
Mailing Address - Fax:
Practice Address - Street 1:3 ERIE CT
Practice Address - Street 2:
Practice Address - City:OAK PARK
Practice Address - State:IL
Practice Address - Zip Code:60302-2519
Practice Address - Country:US
Practice Address - Phone:877-852-4669
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-26
Last Update Date:2011-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical PathologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILCK9230OtherRAILROAD MEDICARE
IL01633353OtherBLUE CROSS BLUE SHIELD
ILCK9230OtherRAILROAD MEDICARE