Provider Demographics
NPI:1205995321
Name:OB GYN SOUTHWEST SC
Entity type:Organization
Organization Name:OB GYN SOUTHWEST SC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:F
Authorized Official - Last Name:LINDGREN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:708-923-7900
Mailing Address - Street 1:13011 S 104TH AVE STE 205
Mailing Address - Street 2:
Mailing Address - City:PALOS PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60464-1512
Mailing Address - Country:US
Mailing Address - Phone:708-923-7900
Mailing Address - Fax:708-923-7915
Practice Address - Street 1:13011 S 104TH AVE STE 203
Practice Address - Street 2:
Practice Address - City:PALOS PARK
Practice Address - State:IL
Practice Address - Zip Code:60464-1512
Practice Address - Country:US
Practice Address - Phone:708-923-7900
Practice Address - Fax:708-923-7915
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-06
Last Update Date:2020-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL042-003718207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
479610Medicare ID - Type Unspecified