Healthcare Provider Details

I. General information

NPI: 1235753229
Provider Name (Legal Business Name): BESAN M SALAMEH PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/04/2020
Last Update Date: 04/29/2026
Certification Date: 04/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15300 WEST AVE STE 122
ORLAND PARK IL
60462-4508
US

IV. Provider business mailing address

15300 WEST AVE STE 122
ORLAND PARK IL
60462-4508
US

V. Phone/Fax

Practice location:
  • Phone: 708-590-5520
  • Fax: 708-590-5524
Mailing address:
  • Phone: 708-590-5520
  • Fax: 708-590-5524

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number085008181
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number2020030334
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: