Provider Demographics
NPI:1043469745
Name:HISTOLOGY CORP
Entity type:Organization
Organization Name:HISTOLOGY CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:J
Authorized Official - Last Name:KELLY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:847-525-3147
Mailing Address - Street 1:21 N SKOKIE HWY
Mailing Address - Street 2:SUITE 202
Mailing Address - City:LAKE BLUFF
Mailing Address - State:IL
Mailing Address - Zip Code:60044-1777
Mailing Address - Country:US
Mailing Address - Phone:847-525-3147
Mailing Address - Fax:
Practice Address - Street 1:21 N SKOKIE HWY
Practice Address - Street 2:SUITE 202
Practice Address - City:LAKE BLUFF
Practice Address - State:IL
Practice Address - Zip Code:60044-1777
Practice Address - Country:US
Practice Address - Phone:847-525-3147
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-09-17
Last Update Date:2016-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes246RH0600XTechnologists, Technicians & Other Technical Service ProvidersTechnician, PathologyHistologyGroup - Single Specialty