MEDICARE: DR. ERICA SALAMAN DO

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	207PE0004X	Emergency Medical Services (Emergency Medicine) Physician	4339	AZ

General Provider Information

NPI Number	:	1093761363
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ERICA SALAMAN DO

Provider Business Mailing Address
First Line	:	1841 W 19TH ST
Second Line	:	2R
City	:	CHICAGO
State	:	IL
Zip	:	60608-2713
Country	:	US
Telephone Number	:	312-563-1943
Fax Number	:	312-563-1943

Provider Business Practice Location Address
First Line	:	1841 W 19TH ST
Second Line	:	2R
City	:	CHICAGO
State	:	IL
Zip	:	60608-2713
Country	:	US
Telephone Number	:	312-563-1943
Fax Number	:	312-563-1943

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

Provider Enumeration Date	:	05/26/2006
Last Update Date	:	07/08/2007

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