Healthcare Provider Details

I. General information

NPI: 1093700551
Provider Name (Legal Business Name): WESTWOOD OBSTETRICS & GYNECOLOGY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/12/2005
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

375 N WALL ST STE P410
KANKAKEE IL
60901-3483
US

IV. Provider business mailing address

375 N WALL ST STE P410
KANKAKEE IL
60901-3483
US

V. Phone/Fax

Practice location:
  • Phone: 815-932-7474
  • Fax: 815-937-8206
Mailing address:
  • Phone: 815-932-7474
  • Fax: 815-937-8206

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number
License Number StateIL

VIII. Authorized Official

Name: DR. ROGER LEON TAYLOR
Title or Position: PRESIDENT
Credential: MD
Phone: 815-932-7474