MEDICARE: RAJA K SALEEM MD SC

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	036118250	IL

General Provider Information

NPI Number	:	1487992467
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RAJA K SALEEM MD SC

Provider Business Mailing Address
First Line	:	948 W US ROUTE 6
Second Line	:
City	:	MORRIS
State	:	IL
Zip	:	60450-8858
Country	:	US
Telephone Number	:	815-942-5474
Fax Number	:	815-942-5498

Provider Business Practice Location Address
First Line	:	948 W US ROUTE 6
Second Line	:
City	:	MORRIS
State	:	IL
Zip	:	60450-8858
Country	:	US
Telephone Number	:	815-942-5474
Fax Number	:	815-942-5498

Authorized Official
Title or Position	:	PRESIDENT
Name	:	RAJA K SALEEM
Credential	:	MD
Telephone Number	:	815-942-5474

Provider Enumeration Date	:	01/24/2013
Last Update Date	:	09/29/2015

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