Healthcare Provider Details

I. General information

NPI: 1508029877
Provider Name (Legal Business Name): MICHAEL SALVINO MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/08/2008
Last Update Date: 06/18/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6311 W 95TH ST THE CENTER FOR RECONSTRUCTIVE SURGERY
OAK LAWN IL
60453
US

IV. Provider business mailing address

PO BOX 99
HINSDALE IL
60522-0099
US

V. Phone/Fax

Practice location:
  • Phone: 630-929-6565
  • Fax: 708-423-2305
Mailing address:
  • Phone: 630-929-6565
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License Number036113600
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: