Provider Demographics
NPI:1265458889
Name:SOUTHWEST MEDICAL CONSULTANTS, S.C.
Entity Type:Organization
Organization Name:SOUTHWEST MEDICAL CONSULTANTS, S.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:S
Authorized Official - Middle Name:
Authorized Official - Last Name:VENKATARAMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:708-636-1818
Mailing Address - Street 1:PO BOX 388320
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60638-8320
Mailing Address - Country:US
Mailing Address - Phone:773-767-4600
Mailing Address - Fax:773-767-8320
Practice Address - Street 1:10458 S PULASKI RD
Practice Address - Street 2:
Practice Address - City:OAK LAWN
Practice Address - State:IL
Practice Address - Zip Code:60453-4933
Practice Address - Country:US
Practice Address - Phone:708-636-1818
Practice Address - Fax:708-636-2151
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SOUTHWEST MEDICAL CONSULTANTS, S.C.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-07-15
Last Update Date:2021-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Multi-Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & OncologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL31601474OtherBLUE CROSS
IL6012510001Medicare NSC
IL31601474OtherBLUE CROSS