Provider Demographics
NPI:1447289210
Name:ELK GROVE LAB PHYSICIANS, P.C.
Entity type:Organization
Organization Name:ELK GROVE LAB PHYSICIANS, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:CARLOS
Authorized Official - Middle Name:S
Authorized Official - Last Name:SHIBATA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:847-437-5500
Mailing Address - Street 1:PO BOX 77-9154
Mailing Address - Street 2:DEPT 77-9154
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60678-0001
Mailing Address - Country:US
Mailing Address - Phone:847-437-5500
Mailing Address - Fax:847-981-2023
Practice Address - Street 1:800 BIESTERFIELD RD
Practice Address - Street 2:
Practice Address - City:ELK GROVE VILLAGE
Practice Address - State:IL
Practice Address - Zip Code:60007-3311
Practice Address - Country:US
Practice Address - Phone:847-437-5500
Practice Address - Fax:847-981-2023
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-02
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical PathologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL951840Medicare ID - Type Unspecified