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NPI Code Detail

MEDICARE: ANTOINETTE SALLAMME M.D.

MEDICARE: ANTOINETTE SALLAMME M.D.
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
1208000000XPediatrics Physician036105336IL

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1336066513OTHERILCONTROLLED SUBSTANCE

General Provider Information

NPI Number : 1790843993
Entity Type Code : Individual
Provider Name (Legal Business Name) : ANTOINETTE SALLAMME M.D.
Provider Business Mailing Address
First Line : 9730 S WESTERN AVE STE 500
Second Line :
City : EVERGREEN PK
State : IL
Zip : 60805-2780
Country : US
Telephone Number : 708-425-7337
Fax Number : 708-636-3485
Provider Business Practice Location Address
First Line : 9730 S WESTERN AVE STE 500
Second Line :
City : EVERGREEN PK
State : IL
Zip : 60805-2780
Country : US
Telephone Number : 708-425-7337
Fax Number : 708-636-3485
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/04/2006
Last Update Date : 04/20/2022

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Directions to “ ANTOINETTE SALLAMME M.D.” Practice Location

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