Provider Demographics
NPI:1871055145
Name:SALVINO, CONOR KEVIN (DPM)
Entity type:Individual
Prefix:DR
First Name:CONOR
Middle Name:KEVIN
Last Name:SALVINO
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:DR
Other - First Name:CONOR
Other - Middle Name:KEVIN
Other - Last Name:SALVINO
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:SALVINO
Mailing Address - Street 1:2850 S WABASH AVE STE 100
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60616-2491
Mailing Address - Country:US
Mailing Address - Phone:312-842-4600
Mailing Address - Fax:
Practice Address - Street 1:2850 S WABASH AVE STE 100
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60616-2491
Practice Address - Country:US
Practice Address - Phone:312-842-4600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-04-04
Last Update Date:2023-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL135.001054213ES0103X, 213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL390200000XMedicaid