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General NPI Number Information
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NPI Number | 1902464647
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Entity Type | Individual
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Provider Name | SAMUEL J TRAVERSO DO
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Gender | Male
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Dates
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Enumeration Date | 05/29/2019
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Last Update Date | 10/10/2025
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Provider Practice Location Address
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Address Line | 5201 WILLOW SPRINGS RD STE 300
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City | LA GRANGE HIGHLANDS
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State | IL
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Zip | 60525-6539
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Country | US
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Telephone | 708-482-8088
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Fax | 708-482-9034
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Provider Business Mailing Address
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Address Line | 5201 WILLOW SPRINGS RD STE 300
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City | LA GRANGE HIGHLANDS
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State | IL
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Zip | 60525-6539
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Country | US
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Telephone | 708-482-8088
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Fax | 708-482-9034
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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 | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 036160173
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License Number State | IL
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