Organization
ORIZON PATHOLOGY FOUNDATION
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ANTIMO CANDEL M.D. (PRESIDENT)
(773) 284-0904
Entity
Organization
Contact information
Practice address
2701 W 68TH ST, CHICAGO, IL 60629-1813
(773) 284-0904
Mailing address
PO BOX 88639, CHICAGO, IL 60680-1639
(773) 284-0904
Taxonomy
Speciality
Code
Description
License number
State
207ZP0102X
Anatomic Pathology & Clinical Pathology Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
01635169
BLUE CROSS BLUE SHIELD
IL
01
—
DD8083
RAILROAD MEDICARE
IL
Enumeration date
06/30/2006
Last updated
01/20/2010
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