1164626917 NPI number — DR. MARIO REY SALAZAR M.D.

Table of content: ASHLYNN TAYLOR ROLLMAN (NPI 1861186207)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1164626917 NPI number — DR. MARIO REY SALAZAR M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SALAZAR
Provider First Name:
MARIO
Provider Middle Name:
REY
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1164626917
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/11/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2015 SPRING RD STE 300
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
OAK BROOK
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
60523-3944
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
630-725-2700
Provider Business Mailing Address Fax Number:
630-725-2873

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1101 PERIMETER DR STE 620
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SCHAUMBURG
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60173-5056
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
847-619-5500
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
06/14/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 208600000X , with the licence number:  M7587 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 208600000X , with the licence number: 35099584 , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 208600000X , with the licence number: 036114108 , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 0068422 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".
  • Identifier: P01574620 . This is a "MEDICARE RAILROAD INDIVIDUAL PTAN" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 340739 . This is a "GROUP MEDICARE PTAN" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 340731 . This is a "GROUP MEDICARE PTAN" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: DV0090 . This is a "MEDICARE RAILROAD GROUP PTAN" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".




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