Healthcare Provider Details

I. General information

NPI: 1427094416
Provider Name (Legal Business Name): SOUTHWEST PEDIATRICS, LTD.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/20/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8100 W 119TH ST
PALOS PARK IL
60464-3041
US

IV. Provider business mailing address

8100 W 119TH ST
PALOS PARK IL
60464-3041
US

V. Phone/Fax

Practice location:
  • Phone: 708-361-3300
  • Fax: 708-361-8139
Mailing address:
  • Phone: 708-361-3300
  • Fax: 708-361-8139

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number StateIL

VIII. Authorized Official

Name: DR. GEORGE FREDERICK HARRIS
Title or Position: PRESIDENT
Credential: M.D.
Phone: 708-361-3300