Provider Demographics
NPI:1629149679
Name:SOUTHWEST FAMILY PRACTICE LTD
Entity Type:Organization
Organization Name:SOUTHWEST FAMILY PRACTICE LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COOWNER
Authorized Official - Prefix:
Authorized Official - First Name:SURINDER
Authorized Official - Middle Name:
Authorized Official - Last Name:SAHAJPAL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:708-361-5007
Mailing Address - Street 1:4861 W 95TH ST
Mailing Address - Street 2:
Mailing Address - City:OAK LAWN
Mailing Address - State:IL
Mailing Address - Zip Code:60453-2521
Mailing Address - Country:US
Mailing Address - Phone:708-361-5007
Mailing Address - Fax:
Practice Address - Street 1:11737 SOUTHWEST HWY STE B
Practice Address - Street 2:
Practice Address - City:PALOS HEIGHTS
Practice Address - State:IL
Practice Address - Zip Code:60463-1912
Practice Address - Country:US
Practice Address - Phone:708-361-5007
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-13
Last Update Date:2008-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL302R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302R00000XManaged Care OrganizationsHealth Maintenance Organization
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILL22480Medicare ID - Type Unspecified
ILC44808Medicare UPIN