Provider Demographics
NPI:1083611800
Name:SALVINO, KEVIN J (DPM)
Entity Type:Individual
Prefix:DR
First Name:KEVIN
Middle Name:J
Last Name:SALVINO
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:DR
Other - First Name:KEVIN
Other - Middle Name:J
Other - Last Name:SALVINO
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DPM
Mailing Address - Street 1:23 W CHICAGO AVE
Mailing Address - Street 2:
Mailing Address - City:HINSDALE
Mailing Address - State:IL
Mailing Address - Zip Code:60521-3401
Mailing Address - Country:US
Mailing Address - Phone:630-789-1700
Mailing Address - Fax:630-789-1748
Practice Address - Street 1:23 W CHICAGO AVE
Practice Address - Street 2:
Practice Address - City:HINSDALE
Practice Address - State:IL
Practice Address - Zip Code:60521-3401
Practice Address - Country:US
Practice Address - Phone:630-789-1700
Practice Address - Fax:630-789-1748
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-07
Last Update Date:2012-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL016-003691213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL600-01523OtherBCBS
IL0806530001OtherDMERC
IL75-9060Medicare PIN
IL600-01523OtherBCBS
IL0806530001Medicare NSC