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Organization
MARIO A SALAZAR MD SC
Active
Organization
MARIO A SALAZAR MD SC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. MARIO A SALAZAR M.D. (PHYSICIAN)
(773) 237-7795
Entity
Organization
Contact information
Practice address
3048 N HARLEM AVE, CHICAGO, IL 60634-4704
(773) 237-7795
Mailing address
3048 N HARLEM AVE, CHICAGO, IL 60634-4704
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
036049655
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
036049655
—
IL
01
—
21605529
BLUE CROSS BLUE SHIELD
IL
Enumeration date
03/15/2010
Last updated
07/19/2010
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