Provider Demographics
NPI:1902902281
Name:ADDISON-CENTRAL PATHOLOGY PLLC
Entity Type:Organization
Organization Name:ADDISON-CENTRAL PATHOLOGY PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:VEN
Authorized Official - Middle Name:
Authorized Official - Last Name:ADUANA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:847-757-7515
Mailing Address - Street 1:2021 MIDWEST RD STE 200
Mailing Address - Street 2:
Mailing Address - City:OAK BROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60523-1370
Mailing Address - Country:US
Mailing Address - Phone:630-874-2542
Mailing Address - Fax:630-874-2642
Practice Address - Street 1:5645 W ADDISON ST
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60634-4403
Practice Address - Country:US
Practice Address - Phone:773-282-7000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-15
Last Update Date:2024-02-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical PathologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL01633170OtherBCBS IL
DA0104OtherRAILROAD MEDICARE
DA0104OtherRAILROAD MEDICARE