Provider Demographics
NPI:1558491134
Name:PATHOLOGY ASSOCIATES OF NORTHERN ILLINOIS, PC
Entity Type:Organization
Organization Name:PATHOLOGY ASSOCIATES OF NORTHERN ILLINOIS, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:LESTER
Authorized Official - Middle Name:J
Authorized Official - Last Name:RAFF
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:847-634-1922
Mailing Address - Street 1:5918 PARTRIDGE LN
Mailing Address - Street 2:
Mailing Address - City:LONG GROVE
Mailing Address - State:IL
Mailing Address - Zip Code:60047-5056
Mailing Address - Country:US
Mailing Address - Phone:847-634-1922
Mailing Address - Fax:708-486-0080
Practice Address - Street 1:2225 ENTERPRISE DR
Practice Address - Street 2:SUITE 2511
Practice Address - City:WESTCHESTER
Practice Address - State:IL
Practice Address - Zip Code:60154-5814
Practice Address - Country:US
Practice Address - Phone:708-486-0076
Practice Address - Fax:708-486-0080
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-06
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical PathologyGroup - Single Specialty