Healthcare Provider Details

I. General information

NPI: 1972814705
Provider Name (Legal Business Name): SALVINO PLASTIC SURGERY MD SC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/25/2010
Last Update Date: 07/06/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6311 W 95TH ST THE CENTER FOR RECONSTRUCTIVE SURGERY
OAK LAWN IL
60453-2201
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: 708-423-2305

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: MICHAEL SALVINO
Title or Position: PHYSICIAN
Credential: M.D.
Phone: 630-929-6565