MEDICARE: SOUTHWEST OBSTETRICS AND GYNECOLOGY, LTD.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207V00000X	Obstetrics & Gynecology Physician	042002689	IL

General Provider Information

NPI Number	:	1225117815
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SOUTHWEST OBSTETRICS AND GYNECOLOGY, LTD.

Provider Business Mailing Address
First Line	:	4225 W 95TH ST
Second Line	:
City	:	OAK LAWN
State	:	IL
Zip	:	60453-2623
Country	:	US
Telephone Number	:	708-423-2300
Fax Number	:	708-423-2318

Provider Business Practice Location Address
First Line	:	4225 W 95TH ST
Second Line	:
City	:	OAK LAWN
State	:	IL
Zip	:	60453-2623
Country	:	US
Telephone Number	:	708-423-2300
Fax Number	:	708-423-2318

Authorized Official
Title or Position	:	PRESIDENT
Name	:	JOSEPH M PAVESE
Credential	:	M.D.
Telephone Number	:	708-423-2300

Provider Enumeration Date	:	11/03/2006
Last Update Date	:	09/25/2008

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