MEDICARE: MARIO A SALAZAR 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	036049655	IL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	21605529	OTHER	IL	BLUE CROSS BLUE SHIELD

General Provider Information

NPI Number	:	1538483953
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MARIO A SALAZAR MD SC

Provider Business Mailing Address
First Line	:	3048 N HARLEM AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60634-4704
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3048 N HARLEM AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60634-4704
Country	:	US
Telephone Number	:	773-237-7795
Fax Number	:

Authorized Official
Title or Position	:	PHYSICIAN
Name	:	DR. MARIO A SALAZAR
Credential	:	M.D.
Telephone Number	:	773-237-7795

Provider Enumeration Date	:	03/15/2010
Last Update Date	:	07/19/2010

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