Provider Demographics
NPI:1114984283
Name:SALARDA, ELVIRA (MD)
Entity Type:Individual
Prefix:
First Name:ELVIRA
Middle Name:
Last Name:SALARDA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:SPARTA MEDICAL OFFICE
Mailing Address - Street 2:215 SOUTH BURNS
Mailing Address - City:SPARTA
Mailing Address - State:IL
Mailing Address - Zip Code:62286
Mailing Address - Country:US
Mailing Address - Phone:618-443-4889
Mailing Address - Fax:
Practice Address - Street 1:SPARTA MEDICAL OFFICE
Practice Address - Street 2:215 SOUTH BURNS
Practice Address - City:SPARTA
Practice Address - State:IL
Practice Address - Zip Code:62286
Practice Address - Country:US
Practice Address - Phone:618-443-4889
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-01
Last Update Date:2020-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036084662207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILF33182Medicare UPIN