Provider Demographics
NPI:1174762256
Name:CONSOLIDATED PATHOLOGY CONSULTANTS, SC
Entity type:Organization
Organization Name:CONSOLIDATED PATHOLOGY CONSULTANTS, SC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:LAB DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:TRACY
Authorized Official - Middle Name:
Authorized Official - Last Name:KNOX
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:847-996-1030
Mailing Address - Street 1:75 REMITTANCE DR
Mailing Address - Street 2:SUITE 1895
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60675-1001
Mailing Address - Country:US
Mailing Address - Phone:847-535-6215
Mailing Address - Fax:
Practice Address - Street 1:28100 N ASHLEY CIR
Practice Address - Street 2:SUITE 106
Practice Address - City:LIBERTYVILLE
Practice Address - State:IL
Practice Address - Zip Code:60048-9478
Practice Address - Country:US
Practice Address - Phone:847-996-1030
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CONSOLIDATED PATHOLOGY CONSULTANTS, SC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2009-02-12
Last Update Date:2024-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL14D1094992291U00000X
207ZP0105X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207ZP0105XAllopathic & Osteopathic PhysiciansPathologyClinical Pathology/Laboratory MedicineGroup - Single Specialty
No291U00000XLaboratoriesClinical Medical LaboratoryGroup - Single Specialty