Healthcare Provider Details

I. General information

NPI: 1619912995
Provider Name (Legal Business Name): SOUTHWEST MEDICAL AND PSYCHIATRIC SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/19/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2850 W 95TH ST SUITE 204
EVERGREEN PARK IL
60805-2735
US

IV. Provider business mailing address

2850 W 95TH ST SUITE 204
EVERGREEN PARK IL
60805-2735
US

V. Phone/Fax

Practice location:
  • Phone: 708-422-5090
  • Fax: 708-422-5990
Mailing address:
  • Phone: 708-422-5090
  • Fax: 708-422-5990

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number State

VIII. Authorized Official

Name: MICHAEL BEDNARZ
Title or Position: OWNER
Credential: M.D.
Phone: 708-422-5090