MIDWEST DERMPATH LLC NPI 1194591529

NPI Information

  • NPI: 1194591529
  • Provider Name: MIDWEST DERMPATH LLC
  • Classification: Pathology - 207ZD0900X
  • Specialization: Dermatopathology
  • Entity Type: Organization
  • CLIA Number: 14D2293395
  • Address: 409 KELLER ST
    BARTONVILLE, IL
    ZIP 61607
  • Phone: (309) 404-6583

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NPI Details

MIDWEST DERMPATH LLC is a dermatopathology pathology in Bartonville, IL. The provider is a dermatopathologist is an expert in diagnosing and monitoring diseases of the skin including infectious, immunologic, degenerative, and neoplastic diseases. This entails the examination and interpretation of specially prepared tissue sections, cellular scrapings, and smears of skin lesions by means of light microscopy, electron microscopy, and fluorescence microscopy. MIDWEST DERMPATH LLC NPI is 1194591529. The provider is registered as an organization entity type and is a single specialty group.

The provider's business location address is:

409 KELLER ST
BARTONVILLE, IL
ZIP 61607-556
Phone: (309) 404-6583

The provider's authorized official is Tesfu Hailu .
The authorized official title is Lab Director and has the following contact phone number (309) 404-6583.

The CLIA number assigned to this NPI record is 14D2293395 - independent with a certificate type of Certificate of Compliance.

The enumeration date for this NPI number is 11/27/2023 and was last updated on 1/31/2024.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
1207ZP0102XPathologyAnatomic Pathology & Clinical PathologyNo
2207ZD0900XPathologyDermatopathologyYes

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 11/21/2025

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