Healthcare Provider Details

I. General information

NPI: 1306921754
Provider Name (Legal Business Name): SOUTHWEST SURGICAL ASSOCIATES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/26/2006
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1300 COPPERFIELD AVE
JOLIET IL
60432-2004
US

IV. Provider business mailing address

10660 W 143RD ST STE B
ORLAND PARK IL
60462-1989
US

V. Phone/Fax

Practice location:
  • Phone: 815-727-4050
  • Fax:
Mailing address:
  • Phone: 708-460-4499
  • Fax: 708-460-8031

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number
License Number StateIN

VIII. Authorized Official

Name: DR. UMESH SHARMA
Title or Position: PRESIDENT
Credential: M.D.
Phone: 815-727-4050