Provider Demographics
NPI:1316206139
Name:SOUTHLAND PHYSICIAN PARTNERS SC
Entity Type:Organization
Organization Name:SOUTHLAND PHYSICIAN PARTNERS SC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:DARREL
Authorized Official - Middle Name:JOSEPH
Authorized Official - Last Name:SALDANHA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:847-212-8227
Mailing Address - Street 1:9680 GOLF RD FL 2
Mailing Address - Street 2:
Mailing Address - City:DES PLAINES
Mailing Address - State:IL
Mailing Address - Zip Code:60016-1522
Mailing Address - Country:US
Mailing Address - Phone:708-987-3795
Mailing Address - Fax:847-352-0423
Practice Address - Street 1:9680 GOLF RD FL 2
Practice Address - Street 2:
Practice Address - City:DES PLAINES
Practice Address - State:IL
Practice Address - Zip Code:60016-1522
Practice Address - Country:US
Practice Address - Phone:708-987-3795
Practice Address - Fax:847-352-0423
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-05-14
Last Update Date:2012-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty