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General NPI Number Information
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NPI Number | 1588754972
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Entity Type | Individual
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Provider Name | SALVADOR SERRANO M.D.
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Gender | Male
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Dates
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Enumeration Date | 10/13/2006
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Last Update Date | 09/08/2009
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Provider Practice Location Address
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Address Line | 3109 W ARMITAGE AVE
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City | CHICAGO
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State | IL
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Zip | 60647-3818
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Country | US
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Telephone | 773-384-4933
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Fax | 773-384-5037
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Provider Business Mailing Address
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Address Line | 3109 W ARMITAGE AVE
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City | CHICAGO
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State | IL
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Zip | 60647-3818
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Country | US
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Telephone | 773-384-4933
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Fax | 773-384-5037
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number | 036073762
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License Number State | IL
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