Organization
SOUTHERN ILLINOIS PATHOLOGY, PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. CHANDRASHEKAR PADMALATHA M.D. (PRESIDENT)
(618) 549-0721
Entity
Organization
Contact information
Practice address
404 W MAIN ST, PATHOLOGY DEPARTMENT, CARBONDALE, IL 62901-2904
(618) 549-0721
Mailing address
231 W MAIN ST, STE BW ATTN: LISA BROWER, CARBONDALE, IL 62901-2948
Taxonomy
Speciality
Code
Description
License number
State
207ZP0102X
Anatomic Pathology & Clinical Pathology Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
14D0436426
—
IL
Enumeration date
12/07/2005
Last updated
03/14/2011
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