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Organization
SOUTHERN ILLINOIS HISTOLOGY, LLC
Active
Organization
SOUTHERN ILLINOIS HISTOLOGY, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DOLPH D HAEGE M.D. (PRESIDENT)
(618) 798-3000
Entity
Organization
Contact information
Practice address
2100 MADISON AVE, GRANITE CITY, IL 62040-4701
(618) 798-3000
Mailing address
PO BOX 144333, ORLANDO, FL 32814-4333
(407) 422-9831
(407) 206-1767
Taxonomy
Speciality
Code
Description
License number
State
207ZP0102X
Anatomic Pathology & Clinical Pathology Physician
Primary
—
—
Other
Enumeration date
01/16/2012
Last updated
01/16/2012
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