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General NPI Number Information
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NPI Number | 1447337548
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Entity Type | Organization
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Legal Business Name | SOUTHWEST INFECTIOUS DISEASE & INTERNAL MEDICINE S C
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Dates
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Enumeration Date | 11/01/2006
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Last Update Date | 11/28/2017
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Provider Practice Location Address
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Address Line | 7804 W COLLEGE DR SUITE 1NW
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City | PALOS HEIGHTS
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State | IL
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Zip | 60463-1025
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Country | US
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Telephone | 708-361-5778
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Fax | 708-361-5631
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Provider Business Mailing Address
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Address Line | 1426 W IRVING PARK RD STE 1
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City | CHICAGO
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State | IL
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Zip | 60613-5699
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Country | US
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Telephone | 708-361-5778
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | JOHN M ANDREONI
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Credential | MD
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Telephone | 630-288-6215
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RI0200X
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Taxonomy Name | Infectious Disease Physician
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License Number |
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License Number State |
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