Provider Demographics
NPI:1780131227
Name:WESTEROS FAMILY PRACTICE, LTD
Entity type:Organization
Organization Name:WESTEROS FAMILY PRACTICE, LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:IRYNA
Authorized Official - Middle Name:
Authorized Official - Last Name:SEREMBYTSKY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:708-442-7174
Mailing Address - Street 1:366 E BURLINGTON ST
Mailing Address - Street 2:
Mailing Address - City:RIVERSIDE
Mailing Address - State:IL
Mailing Address - Zip Code:60546-2152
Mailing Address - Country:US
Mailing Address - Phone:708-442-7174
Mailing Address - Fax:
Practice Address - Street 1:366 E BURLINGTON ST
Practice Address - Street 2:
Practice Address - City:RIVERSIDE
Practice Address - State:IL
Practice Address - Zip Code:60546-2152
Practice Address - Country:US
Practice Address - Phone:708-442-7174
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-09-01
Last Update Date:2023-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036136127207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty