Provider Demographics
NPI:1619042959
Name:CLINICAL PATHOLOGISTS OF LAKE COUNTY, LLC
Entity Type:Organization
Organization Name:CLINICAL PATHOLOGISTS OF LAKE COUNTY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER OF CLINICAL PATHOLOGISTS OF
Authorized Official - Prefix:DR
Authorized Official - First Name:PATRICIA
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:KAMPMEIER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:847-990-5154
Mailing Address - Street 1:28590 THORNGATE DR
Mailing Address - Street 2:
Mailing Address - City:MUNDELEIN
Mailing Address - State:IL
Mailing Address - Zip Code:60060-5329
Mailing Address - Country:US
Mailing Address - Phone:847-566-6475
Mailing Address - Fax:847-566-6375
Practice Address - Street 1:801 S MILWAUKEE AVE
Practice Address - Street 2:
Practice Address - City:LIBERTYVILLE
Practice Address - State:IL
Practice Address - Zip Code:60048-3204
Practice Address - Country:US
Practice Address - Phone:847-990-5154
Practice Address - Fax:847-918-0713
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-21
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical PathologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL=========OtherTAXPAYER IDENTIFICATION