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Active
Organization subpart
No

Provider details

NPI number
Authorized official
MS. MARY E VOGT (CFO)
(847) 781-2500
Entity
Organization

Contact information

Practice address
2401 HASSELL RD, SUITE 1510, HOFFMAN ESTATES, IL 60195-2096
(847) 781-2500
(847) 781-2560
Mailing address
2401 HASSELL RD, SUITE 1510, HOFFMAN ESTATES, IL 60195-2096
(847) 781-2500
(847) 781-2560

Taxonomy

Speciality
Code
Description
License number
State
291U00000X
Clinical Medical Laboratory
Primary
IL

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
1634137
BLUECROSS BLUE SHEILD
IL
Enumeration date
05/24/2007
Last updated
08/22/2020
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