| Southwest Medical Group Ltd | |
|
4316 N Elston Ave Chicago IL 60641-2144 | |
| (773) 754-3728 | |
| (773) 754-3504 |
| Full Name | Southwest Medical Group Ltd |
|---|---|
| Speciality | Family Medicine |
| Location | 4316 N Elston Ave, Chicago, Illinois |
| Authorized Official Name and Position | Farooq M Ahmed (PRESIDENT) |
| Authorized Official Contact | 7737543728 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Southwest Medical Group Ltd 4316 N Elston Ave Chicago IL 60641-2144 Ph: (773) 754-3728 | Southwest Medical Group Ltd 4316 N Elston Ave Chicago IL 60641-2144 Ph: (773) 754-3728 |
| NPI Number | 1306114426 |
|---|---|
| Provider Enumeration Date | 12/03/2011 |
| Last Update Date | 12/03/2011 |
| Medicare PECOS PAC ID | 1153585658 |
|---|---|
| Medicare Enrollment ID | O20120613000579 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1306114426 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | 036118695 (Illinois) | Primary |
| Provider Name | Farooq M Ahmed |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1275553240 PECOS PAC ID: 7719089127 Enrollment ID: I20071103000117 |
| Provider Name | Clarence P Abella |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1962513523 PECOS PAC ID: 1355491747 Enrollment ID: I20090605000040 |
| Provider Name | Judita Slusnys |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1770956476 PECOS PAC ID: 2466762802 Enrollment ID: I20151113001951 |
| Provider Name | Saad Khan |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1831541796 PECOS PAC ID: 8820355480 Enrollment ID: I20171206003026 |
| Provider Name | Audrey Leticia Cofie |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1477227718 PECOS PAC ID: 2365836723 Enrollment ID: I20220228002768 |
| Provider Name | Asad Khaleel Khan |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1144893058 PECOS PAC ID: 0941698757 Enrollment ID: I20230608003303 |
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