Organization
EDMUND J LEWIS
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. SAMUEL NEAL SALTZBERG DR (DOCTOR)
(312) 829-1424
Entity
Organization
Contact information
Practice address
1426 W WASHINGTON BLVD, CHICAGO, IL 60607-1821
(312) 829-1424
(312) 850-8431
Mailing address
PO BOX 72354, CLEVELAND, OH 44192-0002
(312) 829-1424
(312) 850-8431
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
036082043
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
01615381
BLUECROSS ID #
IL
05
—
036082043
—
IL
01
—
390002208RR
RAILROAD MC ID#
IL
Enumeration date
12/21/2006
Last updated
12/30/2021
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