Healthcare Provider Details

I. General information

NPI: 1063517035
Provider Name (Legal Business Name): SALIM KASSAM MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/14/2006
Last Update Date: 01/14/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1756 SIBLEY BLVD
CALUMET CITY IL
60409-2215
US

IV. Provider business mailing address

1756 SIBLEY BLVD
CALUMET CITY IL
60409-2215
US

V. Phone/Fax

Practice location:
  • Phone: 708-730-3900
  • Fax: 773-637-2006
Mailing address:
  • Phone: 708-730-3900
  • Fax: 773-637-2006

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: