Organization
CLINICAL PATHOLOGISTS OF CENTRAL ILLINOIS, S.C.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DOUGLAS SHEVLIN M.D. (PRESIDENT)
(217) 522-7004
Entity
Organization
Contact information
Practice address
701 N 1ST ST, SPRINGFIELD, IL 62781-0001
(217) 522-7004
Mailing address
PO BOX 5987, CAROL STREAM, IL 60197-5987
(217) 522-7004
Taxonomy
Speciality
Code
Description
License number
State
207ZP0105X
Clinical Pathology/Laboratory Medicine Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
08423059
BLUE CROSS BLUE SHIELD
IL
Enumeration date
06/25/2006
Last updated
03/22/2010
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