Provider Demographics
NPI:1972812501
Name:WESTWOOD MEDICAL CETER INC
Entity Type:Organization
Organization Name:WESTWOOD MEDICAL CETER INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:RAMESH
Authorized Official - Middle Name:RAMCHANDRA
Authorized Official - Last Name:KHARWADKAR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:773-412-8452
Mailing Address - Street 1:3349 LAKESIDE AVENUE
Mailing Address - Street 2:
Mailing Address - City:NORTHBROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60062
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:6326 S. ASHLAND AVENUE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60636
Practice Address - Country:US
Practice Address - Phone:773-412-8452
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-09-30
Last Update Date:2010-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036-054560208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036.054560Medicaid
IL036.054560Medicaid