Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207R00000X | Internist | 036149724 | IL |
Y | 111NI0900X | Internist | 036149724 | IL |
N | 207R00000X | Internist | 125.069407 | IL |
N | 111NI0900X | Internist | 125.069407 | IL |
NPI | 1003266297 |
---|---|
Provider Name | Sally Salman |
First Address | Chicago, IL 60674-3401 |
Second Address | Lisle, IL 60532-1348 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/06/2016 |
Last Update Date | 06/10/2021 |