Healthcare Provider Details

I. General information

NPI: 1376047589
Provider Name (Legal Business Name): ALAN GUILLERMO SALAZAR MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/21/2018
Last Update Date: 12/04/2024
Certification Date: 12/04/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

901 MCCLINTOCK DR STE 201
BURR RIDGE IL
60527-0872
US

IV. Provider business mailing address

901 MCCLINTOCK DR STE 201
BURR RIDGE IL
60527-0872
US

V. Phone/Fax

Practice location:
  • Phone: 630-654-4201
  • Fax: 630-654-4253
Mailing address:
  • Phone: 630-654-4201
  • Fax: 630-654-4253

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number036.156594
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code207RI0200X
TaxonomyInfectious Disease Physician
License Number036156594
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: