Healthcare Provider Details

I. General information

NPI: 1104404458
Provider Name (Legal Business Name): HAMZA SALAM DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/30/2021
Last Update Date: 06/11/2026
Certification Date: 06/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

199 W RAND RD STE 203
MOUNT PROSPECT IL
60056-1157
US

IV. Provider business mailing address

2650 RIDGE AVE. SUITE 1223
EVANSTON IL
60201-1700
US

V. Phone/Fax

Practice location:
  • Phone: 847-618-5450
  • Fax: 847-618-5459
Mailing address:
  • Phone: 847-618-5450
  • Fax: 847-618-5459

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number036166504
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: