Provider Demographics
NPI:1184756256
Name:ELGIN LABORATORY PHYSICIANS, LTD.
Entity type:Organization
Organization Name:ELGIN LABORATORY PHYSICIANS, LTD.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CATHERINE
Authorized Official - Middle Name:T
Authorized Official - Last Name:BRITTON-KUZEL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:847-875-8478
Mailing Address - Street 1:25286 W HICKORY ST
Mailing Address - Street 2:
Mailing Address - City:ANTIOCH
Mailing Address - State:IL
Mailing Address - Zip Code:60002-7500
Mailing Address - Country:US
Mailing Address - Phone:630-279-3994
Mailing Address - Fax:630-628-6519
Practice Address - Street 1:1 KISH HOSPITAL DR
Practice Address - Street 2:
Practice Address - City:DEKALB
Practice Address - State:IL
Practice Address - Zip Code:60115-9602
Practice Address - Country:US
Practice Address - Phone:815-866-7524
Practice Address - Fax:815-754-1177
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-12
Last Update Date:2024-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036-082562207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical PathologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
987540Medicare ID - Type UnspecifiedMEDICARE