Organization
SOUTHWEST REHABILITATION, S.C.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
RONALD MOCHIZUKI M.D. (PRESIDENT)
(708) 923-5055
Entity
Organization
Contact information
Practice address
12251 S 80TH AVE, PALOS HEIGHTS, IL 60463-1256
(708) 923-5055
(708) 923-5058
Mailing address
PO BOX 388320, CHICAGO, IL 60638-8320
(773) 767-4600
(773) 767-8320
Taxonomy
Speciality
Code
Description
License number
State
208100000X
Physical Medicine & Rehabilitation Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
01620954
BLUE SHIELD
IL
Enumeration date
07/16/2006
Last updated
08/26/2009
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