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General NPI Number Information
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NPI Number | 1730203795
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Entity Type | Organization
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Legal Business Name | SOUTHWEST INFECTIOUS DISEASE ASSOCIATES LTD
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Dates
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Enumeration Date | 03/16/2007
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Last Update Date | 08/31/2012
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Provider Practice Location Address
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Address Line | 1051 ESSINGTON RD SUITE 210
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City | JOLIET
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State | IL
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Zip | 60435-2801
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Country | US
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Telephone | 815-726-1818
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Fax | 815-726-0232
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Provider Business Mailing Address
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Address Line | 1051 ESSINGTON RD SUITE 210
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City | JOLIET
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State | IL
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Zip | 60435-2801
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Country | US
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Telephone | 815-726-1818
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Fax | 815-726-0232
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Authorized Official
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Title or Position | MANAGER
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Name | DEBBIE DIAMOND
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Credential |
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Telephone | 815-726-1818
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | 042006914
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License Number State | IL
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