Provider Demographics
NPI:1497199350
Name:PHYSICIAN DIAGNOSTIC AND PATHOLOGY
Entity Type:Organization
Organization Name:PHYSICIAN DIAGNOSTIC AND PATHOLOGY
Other - Org Name:ASSOCIATED UROLOGICAL SPEC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:S
Authorized Official - Last Name:FIRLIT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:708-361-0840
Mailing Address - Street 1:10400 SOUTHWEST HWY
Mailing Address - Street 2:LOWER LEVEL
Mailing Address - City:CHICAGO RIDGE
Mailing Address - State:IL
Mailing Address - Zip Code:60415-1367
Mailing Address - Country:US
Mailing Address - Phone:708-590-8770
Mailing Address - Fax:708-428-4277
Practice Address - Street 1:7530 W COLLEGE DR
Practice Address - Street 2:
Practice Address - City:PALOS HEIGHTS
Practice Address - State:IL
Practice Address - Zip Code:60463-1196
Practice Address - Country:US
Practice Address - Phone:708-361-8162
Practice Address - Fax:708-361-8173
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ASSOCIATED UROLOGICAL SPECIALISTS
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2013-04-23
Last Update Date:2013-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207ZC0006XAllopathic & Osteopathic PhysiciansPathologyClinical PathologyGroup - Multi-Specialty
No2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Multi-Specialty