Provider Demographics
NPI:1619946993
Name:CHICAGO NEUROPATHOLOGY SERVICE
Entity Type:Organization
Organization Name:CHICAGO NEUROPATHOLOGY SERVICE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JAMIE
Authorized Official - Middle Name:
Authorized Official - Last Name:JACOBSOHN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:847-498-7512
Mailing Address - Street 1:DEPT 77-9452
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60678-9452
Mailing Address - Country:US
Mailing Address - Phone:847-676-0091
Mailing Address - Fax:847-676-2374
Practice Address - Street 1:5 REVERE DR
Practice Address - Street 2:SUITE 200
Practice Address - City:NORTHBROOK
Practice Address - State:IL
Practice Address - Zip Code:60062-1566
Practice Address - Country:US
Practice Address - Phone:847-498-7512
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-17
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL207ZN0500X, 207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered207ZN0500XAllopathic & Osteopathic PhysiciansPathologyNeuropathologyGroup - Multi-Specialty
Not Answered207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical PathologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL01623068OtherBLUE CROSS BLUE SHIELD
IL01623068OtherBLUE CROSS BLUE SHIELD