Healthcare Provider Details

I. General information

NPI: 1487992467
Provider Name (Legal Business Name): RAJA K SALEEM MD SC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/24/2013
Last Update Date: 09/29/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

948 W US ROUTE 6
MORRIS IL
60450-8858
US

IV. Provider business mailing address

948 W US ROUTE 6
MORRIS IL
60450-8858
US

V. Phone/Fax

Practice location:
  • Phone: 815-942-5474
  • Fax: 815-942-5498
Mailing address:
  • Phone: 815-942-5474
  • Fax: 815-942-5498

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number036118250
License Number StateIL

VIII. Authorized Official

Name: RAJA K SALEEM
Title or Position: PRESIDENT
Credential: MD
Phone: 815-942-5474