Individual
DR. MARIO A. SALAZAR
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
3048 N HARLEM AVE, CHICAGO, IL 60634-4704
(773) 237-7795
(773) 237-7547
Mailing address
3048 N HARLEM AVE, CHICAGO, IL 60634-4704
(773) 237-7795
(773) 237-7547
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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