Healthcare Provider Details

I. General information

NPI: 1073666749
Provider Name (Legal Business Name): LARRY M SALBERG M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/18/2007
Last Update Date: 02/24/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

521 E 86TH AVE SUITE Z
MERRILLVILLE IN
46410-6173
US

IV. Provider business mailing address

521 E 86TH AVE SUITE Z
MERRILLVILLE IN
46410-6173
US

V. Phone/Fax

Practice location:
  • Phone: 219-769-0777
  • Fax: 219-755-0612
Mailing address:
  • Phone: 219-769-0777
  • Fax: 219-755-0612

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084N0402X
TaxonomyNeurology with Special Qualifications in Child Neurology Physician
License Number01025163
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: