Provider Demographics
NPI:1861573727
Name:PATHOLOGY ASSOCIATES OF CHICAGO LTD
Entity type:Organization
Organization Name:PATHOLOGY ASSOCIATES 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 PHD
Authorized Official - Phone:708-597-2000
Mailing Address - Street 1:PO BOX 88487
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60680-1487
Mailing Address - Country:US
Mailing Address - Phone:708-597-2000
Mailing Address - Fax:708-597-4275
Practice Address - Street 1:12935 GREGORY ST
Practice Address - Street 2:METROSOUTH MEDICAL CENTER
Practice Address - City:BLUE ISLAND
Practice Address - State:IL
Practice Address - Zip Code:60406-2428
Practice Address - Country:US
Practice Address - Phone:708-597-2000
Practice Address - Fax:708-597-4275
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-18
Last Update Date:2012-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical PathologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN208480Medicare ID - Type Unspecified
IL335310Medicare ID - Type Unspecified