Provider Demographics
NPI:1003884206
Name:CONSOLIDATED PATHOLOGY CONSULTANTS SC
Entity type:Organization
Organization Name:CONSOLIDATED PATHOLOGY CONSULTANTS SC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:D
Authorized Official - Last Name:WANG
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:847-996-1030
Mailing Address - Street 1:75 REMIHANCE DR
Mailing Address - Street 2:SUITE 1895
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60675-1895
Mailing Address - Country:US
Mailing Address - Phone:847-234-0049
Mailing Address - Fax:847-234-1946
Practice Address - Street 1:1000 N WESTMORELAND RD
Practice Address - Street 2:
Practice Address - City:LAKE FOREST
Practice Address - State:IL
Practice Address - Zip Code:60045-1658
Practice Address - Country:US
Practice Address - Phone:847-996-1030
Practice Address - Fax:847-996-0791
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-14
Last Update Date:2020-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical PathologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL04920820OtherBCBS IL
IL04920820OtherBCBS IL