Provider Demographics
NPI:1629006283
Name:ORIZON PATHOLOGY FOUNDATION
Entity Type:Organization
Organization Name:ORIZON PATHOLOGY FOUNDATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ANTIMO
Authorized Official - Middle Name:
Authorized Official - Last Name:CANDEL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:773-284-0904
Mailing Address - Street 1:PO BOX 88639
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60680-1639
Mailing Address - Country:US
Mailing Address - Phone:773-284-0904
Mailing Address - Fax:
Practice Address - Street 1:2701 W 68TH ST
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60629-1813
Practice Address - Country:US
Practice Address - Phone:773-284-0904
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-30
Last Update Date:2010-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical PathologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL01635169OtherBLUE CROSS BLUE SHIELD
ILDD8083OtherRAILROAD MEDICARE
IL212199Medicare ID - Type Unspecified