1649347881 NPI number — DR. ROLANDO SALVATIERRA SAJOR MD

Table of content: DR. ROLANDO SALVATIERRA SAJOR MD (NPI 1649347881)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1649347881 NPI number — DR. ROLANDO SALVATIERRA SAJOR MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SAJOR
Provider First Name:
ROLANDO
Provider Middle Name:
SALVATIERRA
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MD
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:
1649347881
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/29/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
209 N WHISPERING HILLS DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
NAPERVILLE
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
60540
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
630-865-1525
Provider Business Mailing Address Fax Number:
773-378-8100

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
7257 W TOUHY AVE
Provider Second Line Business Practice Location Address:
SUITE 201A
Provider Business Practice Location Address City Name:
CHICAGO
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60631-4342
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
773-631-6000
Provider Business Practice Location Address Fax Number:
773-894-7772
Provider Enumeration Date:
11/30/2006

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: 208D00000X , with the licence number:  036070414 , 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: 0001620482 . This is a "BLUE CROSS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 036070414 , issued by the state of ( IL ) . This identifiers is of the category "MEDICAID".




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