Provider Demographics
NPI:1780070466
Name:PATHFINDER MEDICAL GROUP
Entity type:Organization
Organization Name:PATHFINDER MEDICAL GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:NATASHA
Authorized Official - Middle Name:
Authorized Official - Last Name:KUHNS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:847-915-6389
Mailing Address - Street 1:272 E DEERPATH
Mailing Address - Street 2:SUITE 204
Mailing Address - City:LAKE FOREST
Mailing Address - State:IL
Mailing Address - Zip Code:60045-5314
Mailing Address - Country:US
Mailing Address - Phone:847-915-6389
Mailing Address - Fax:847-686-2020
Practice Address - Street 1:301 MCCULLOUGH DR
Practice Address - Street 2:SUITE 400
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28262-3310
Practice Address - Country:US
Practice Address - Phone:847-915-6389
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PATHFINDER MEDICAL GROUP OF TEXAS PLLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2015-04-09
Last Update Date:2015-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2083P0901XAllopathic & Osteopathic PhysiciansPreventive MedicinePublic Health & General Preventive MedicineGroup - Single Specialty