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Individual
DR. MARIO A. SALAZAR
Active
Individual
DR. MARIO A. SALAZAR
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
036-049655
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
036049655
—
IL
01
—
21605529
BLUE CROSS/BLUE SHIELD
IL
01
—
363129476
TAX ID
IL
Enumeration date
09/21/2006
Last updated
07/08/2007
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