Organization
PATHOLOGY ASSOCIATES OF CENTRAL ILLI
Active
Organization subpart
No
Provider details
NPI number
Authorized official
SANJAI NAGENDRA M.D. (MEDICAL DIRECTOR)
(586) 412-4379
Entity
Organization
Contact information
Practice address
200 HEALTHCARE DRIVE, GREENVILLE, IL 62246-1154
(618) 664-1230
Mailing address
44000 GARFIELD ROAD, CLINTON TOWNSHIP, MI 48038
(586) 412-4379
(586) 412-4102
Taxonomy
Speciality
Code
Description
License number
State
207ZP0102X
Anatomic Pathology & Clinical Pathology Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
CC5544
RRMC
IL
Enumeration date
10/22/2008
Last updated
10/10/2011
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