Basic Information
| Provider Information | |||||||||
| NPI: | 1659710143 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | WESTSIDE MEDICAL CONSULTANTS, LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1730 PARK ST | ||||||||
| Address2: | SUITE 101 | ||||||||
| City: | NAPERVILLE | ||||||||
| State: | IL | ||||||||
| PostalCode: | 605632688 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6307180200 | ||||||||
| FaxNumber: | 6307180900 | ||||||||
| Practice Location | |||||||||
| Address1: | 1611 W HARRISON ST | ||||||||
| Address2: | SUITE 217 | ||||||||
| City: | CHICAGO | ||||||||
| State: | IL | ||||||||
| PostalCode: | 606124861 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3129424040 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 06/18/2013 | ||||||||
| LastUpdateDate: | 06/18/2013 | ||||||||
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| AuthorizedOfficialLastName: | BUYER | ||||||||
| AuthorizedOfficialFirstName: | DAVID | ||||||||
| AuthorizedOfficialMiddleName: | R | ||||||||
| AuthorizedOfficialTitleorPosition: | PHYSICIAN OWNER | ||||||||
| AuthorizedOfficialTelephone: | 3129424040 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | M.D. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine |
No ID Information.