# SOUTHWEST MEDICAL AFFILIATES, PC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1760603054
- **Authorized official:** SHARON L MORIARTY (FINANCIAL SPECIALIST)
- **Authorized official phone:** (708) 857-5804

## Contact information

- **Practice address:** 5630 111TH ST, CHICAGO RIDGE, IL 60415-2406
- **Practice address phone:** (708) 857-5800
- **Practice address fax:** (708) 857-5805
- **Mailing address:** 5630 111TH ST, CHICAGO RIDGE, IL 60415-2406
- **Mailing address phone:** (708) 857-5800
- **Mailing address fax:** (708) 857-5805

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207R00000X | Internal Medicine Physician | 036063034 | IL | — |
| 208000000X | Pediatrics Physician | 036063793 | IL | — |
| 213ES0103X | Foot & Ankle Surgery Podiatrist | 016004378 | IL | Yes |

## Other

- **Enumeration date:** 05/02/2007
- **Last updated:** 11/20/2012