Organization
BLUE ISLAND PATHOLOGY LTD
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. PATTY A MANCUSO (OFFICE MANAGER)
(708) 388-0423
Entity
Organization
Contact information
Practice address
12935 GREGORY ST, BLUE ISLAND, IL 60406-2428
(708) 597-2000
Mailing address
3300 BURR OAK AVE, 2ND FLOOR, BLUE ISLAND, IL 60406-3802
(708) 388-0423
(708) 388-1477
Taxonomy
Speciality
Code
Description
License number
State
207ZC0500X
Cytopathology Physician
Primary
—
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
01619974
BCBS OF IL
IL
Enumeration date
07/09/2006
Last updated
07/21/2022
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