Provider Demographics
NPI:1619912995
Name:SOUTHWEST MEDICAL AND PSYCHIATRIC SERVICES
Entity Type:Organization
Organization Name:SOUTHWEST MEDICAL AND PSYCHIATRIC SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:BEDNARZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:708-422-5090
Mailing Address - Street 1:2850 W 95TH ST
Mailing Address - Street 2:SUITE 204
Mailing Address - City:EVERGREEN PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60805-2735
Mailing Address - Country:US
Mailing Address - Phone:708-422-5090
Mailing Address - Fax:708-422-5990
Practice Address - Street 1:2850 W 95TH ST
Practice Address - Street 2:SUITE 204
Practice Address - City:EVERGREEN PARK
Practice Address - State:IL
Practice Address - Zip Code:60805-2735
Practice Address - Country:US
Practice Address - Phone:708-422-5090
Practice Address - Fax:708-422-5990
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-19
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Not Answered2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Multi-Specialty