Organization
MIDWEST DERMPATH LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
TESFU HAILU MD (LAB DIRECTOR)
(309) 404-6583
Entity
Organization
Contact information
Practice address
409 KELLER ST, BARTONVILLE, IL 61607-2556
(309) 404-6583
Mailing address
409 KELLER ST, BARTONVILLE, IL 61607-2556
(309) 404-6583
Taxonomy
Speciality
Code
Description
License number
State
207ZD0900X
Dermatopathology (Pathology) Physician
Primary
—
—
207ZP0102X
Anatomic Pathology & Clinical Pathology Physician
—
—
Other
Enumeration date
11/27/2023
Last updated
01/31/2024
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