MEDICARE: SALIM KASSAM MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician		IL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	01605103	OTHER	IL	BLUE SHIELD OF IL

General Provider Information

NPI Number	:	1063517035
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SALIM KASSAM MD

Provider Business Mailing Address
First Line	:	1756 SIBLEY BLVD
Second Line	:
City	:	CALUMET CITY
State	:	IL
Zip	:	60409-2215
Country	:	US
Telephone Number	:	708-730-3900
Fax Number	:	773-637-2006

Provider Business Practice Location Address
First Line	:	1756 SIBLEY BLVD
Second Line	:
City	:	CALUMET CITY
State	:	IL
Zip	:	60409-2215
Country	:	US
Telephone Number	:	708-730-3900
Fax Number	:	773-637-2006

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/14/2006
Last Update Date	:	01/14/2008

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Directions to “ SALIM KASSAM MD” Practice Location

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