Healthcare Provider Details

I. General information

NPI: 1851359772
Provider Name (Legal Business Name): JANICE HOSKI SALEM M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 05/02/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1525 W BELMONT AVE LAKEVIEW PEDIATRICS , SUITE 103
CHICAGO IL
60657-7176
US

IV. Provider business mailing address

1722 W SCHOOL ST
CHICAGO IL
60657-1037
US

V. Phone/Fax

Practice location:
  • Phone: 773-880-1738
  • Fax: 773-472-7395
Mailing address:
  • Phone: 773-755-0954
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: