Provider Demographics
NPI:1164626917
Name:SALAZAR, MARIO REY (MD)
Entity Type:Individual
Prefix:DR
First Name:MARIO
Middle Name:REY
Last Name:SALAZAR
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2015 SPRING RD STE 300
Mailing Address - Street 2:
Mailing Address - City:OAK BROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60523-3944
Mailing Address - Country:US
Mailing Address - Phone:630-725-2700
Mailing Address - Fax:630-725-2873
Practice Address - Street 1:1101 PERIMETER DR STE 620
Practice Address - Street 2:
Practice Address - City:SCHAUMBURG
Practice Address - State:IL
Practice Address - Zip Code:60173-5056
Practice Address - Country:US
Practice Address - Phone:847-619-5500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-06-14
Last Update Date:2022-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXM7587208600000X
OH35099584208600000X
IL036114108208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0068422Medicaid
TXP01574620OtherMEDICARE RAILROAD INDIVIDUAL PTAN
TX340739OtherGROUP MEDICARE PTAN
TX340731OtherGROUP MEDICARE PTAN
TXDV0090OtherMEDICARE RAILROAD GROUP PTAN
TX293421YY2GMedicare PIN
TX340739OtherGROUP MEDICARE PTAN
OH0068422Medicaid