Provider Demographics
NPI:1972641223
Name:WESTSIDE MEDICAL ASSOCS, LTD.
Entity Type:Organization
Organization Name:WESTSIDE MEDICAL ASSOCS, LTD.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:DR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:C
Authorized Official - Last Name:MATTIS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:630-932-2020
Mailing Address - Street 1:2340 S HIGHLAND AVE
Mailing Address - Street 2:SUITE 210
Mailing Address - City:LOMBARD
Mailing Address - State:IL
Mailing Address - Zip Code:60148-5371
Mailing Address - Country:US
Mailing Address - Phone:630-932-2020
Mailing Address - Fax:630-932-4688
Practice Address - Street 1:2340 S HIGHLAND AVE
Practice Address - Street 2:SUITE 210
Practice Address - City:LOMBARD
Practice Address - State:IL
Practice Address - Zip Code:60148-5371
Practice Address - Country:US
Practice Address - Phone:630-932-2020
Practice Address - Fax:630-932-4688
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-01
Last Update Date:2010-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty