Provider Demographics
NPI:1871524629
Name:GIOVANNI SALERNO MD PC
Entity type:Organization
Organization Name:GIOVANNI SALERNO MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:GIOVANNI
Authorized Official - Middle Name:
Authorized Official - Last Name:SALERNO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:815-933-7900
Mailing Address - Street 1:461 BROWN BLVD
Mailing Address - Street 2:
Mailing Address - City:BOURBONNAIS
Mailing Address - State:IL
Mailing Address - Zip Code:60914-2322
Mailing Address - Country:US
Mailing Address - Phone:815-933-7900
Mailing Address - Fax:815-933-7090
Practice Address - Street 1:461 BROWN BLVD
Practice Address - Street 2:
Practice Address - City:BOURBONNAIS
Practice Address - State:IL
Practice Address - Zip Code:60914-2322
Practice Address - Country:US
Practice Address - Phone:815-933-7900
Practice Address - Fax:815-933-7090
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-06
Last Update Date:2010-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILDC7518OtherRAILROAD MEDICARE GROUP
IL04622763OtherBCBS
IL14D0918525OtherCLIA
IL04622763OtherBCBS