Healthcare Provider Details

I. General information

NPI: 1871780304
Provider Name (Legal Business Name): SOUTHWEST MEDICAL CONSULTANTS, S.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/28/2007
Last Update Date: 12/31/2021
Certification Date: 12/31/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6853 KINGERY HWY
WILLOWBROOK IL
60527-5114
US

IV. Provider business mailing address

PO BOX 388320
CHICAGO IL
60638-8320
US

V. Phone/Fax

Practice location:
  • Phone: 630-230-0510
  • Fax:
Mailing address:
  • Phone: 773-767-8283
  • Fax: 773-767-8320

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License Number036046355
License Number StateIL

VIII. Authorized Official

Name: S VENKATARAMAN
Title or Position: PRESIDENT
Credential: MD
Phone: 708-636-1818