Provider Demographics
NPI:1689690562
Name:PATHOLOGY CONSULTANTS OF CHICAGO, LTD.
Entity Type:Organization
Organization Name:PATHOLOGY CONSULTANTS OF CHICAGO, LTD.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ENRIQUE
Authorized Official - Middle Name:
Authorized Official - Last Name:BECKMANN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:630-918-5473
Mailing Address - Street 1:PO BOX 88493
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60680-1493
Mailing Address - Country:US
Mailing Address - Phone:312-567-1221
Mailing Address - Fax:
Practice Address - Street 1:2525 S MICHIGAN AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60616-2333
Practice Address - Country:US
Practice Address - Phone:312-567-1221
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-14
Last Update Date:2019-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical PathologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL01622983OtherBLUE CROSS BLUE SHIELD
ILCI8616OtherRAILROAD MEDICARE
IL01622983OtherBLUE CROSS BLUE SHIELD