Healthcare Provider Details

I. General information

NPI: 1790843993
Provider Name (Legal Business Name): ANTOINETTE SALLAMME M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/04/2006
Last Update Date: 04/20/2022
Certification Date: 04/20/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9730 S WESTERN AVE STE 500
EVERGREEN PK IL
60805-2780
US

IV. Provider business mailing address

9730 S WESTERN AVE STE 500
EVERGREEN PK IL
60805-2780
US

V. Phone/Fax

Practice location:
  • Phone: 708-425-7337
  • Fax: 708-636-3485
Mailing address:
  • Phone: 708-425-7337
  • Fax: 708-636-3485

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number036105336
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: