1588832810 NPI number — MANAV K. SALWAN MD SC

Table of content: (NPI 1588832810)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1588832810 NPI number — MANAV K. SALWAN MD SC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MANAV K. SALWAN MD SC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
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:
1588832810
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/30/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2540 HAUSER-ROSS DRIVE
Provider Second Line Business Mailing Address:
SUITE 275
Provider Business Mailing Address City Name:
SYCAMORE
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
60178-3178
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
815-758-4189
Provider Business Mailing Address Fax Number:
815-758-4953

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2540 HAUSER-ROSS DRIVE
Provider Second Line Business Practice Location Address:
SUITE 275
Provider Business Practice Location Address City Name:
SYCAMORE
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60178-3178
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
815-758-4189
Provider Business Practice Location Address Fax Number:
815-758-4953
Provider Enumeration Date:
02/20/2008

Additional Information

Authorized Official

Authorized Official Last Name:
SALWAN
Authorized Official First Name:
MANAV
Authorized Official Middle Name:
K
Authorized Official Title or Position:
PHYSICIAN/PRESIDENT
Authorized Official Telephone Number:
815-758-4189

Provider Taxonomy Codes

  • Taxonomy code: 207R00000X , with the licence number:  036116971 , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207R00000X , with the licence number: 036-116971 , 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: 036116971 , issued by the state of ( IL ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2025 www.npivalidator.com