Healthcare Provider Details

I. General information

NPI: 1477561553
Provider Name (Legal Business Name): ATIYEH SALEM DPM
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/04/2006
Last Update Date: 09/26/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7226 W COLLEGE DR
PALOS HEIGHTS IL
60463-1145
US

IV. Provider business mailing address

7226 W COLLEGE DRIVE
PALOS HTS IL
60463-1145
US

V. Phone/Fax

Practice location:
  • Phone: 708-845-6565
  • Fax: 708-448-9380
Mailing address:
  • Phone: 708-448-9300
  • Fax: 708-448-9380

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number016033399
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number016003399
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: