Provider Demographics
NPI:1275031130
Name:THOMAS G. SALVI, MD, LLC
Entity Type:Organization
Organization Name:THOMAS G. SALVI, MD, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN OWNER
Authorized Official - Prefix:
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:G
Authorized Official - Last Name:SALVI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:224-333-0928
Mailing Address - Street 1:1106 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:ALGONQUIN
Mailing Address - State:IL
Mailing Address - Zip Code:60102-3482
Mailing Address - Country:US
Mailing Address - Phone:224-333-0928
Mailing Address - Fax:
Practice Address - Street 1:1106 N MAIN ST
Practice Address - Street 2:
Practice Address - City:ALGONQUIN
Practice Address - State:IL
Practice Address - Zip Code:60102-3482
Practice Address - Country:US
Practice Address - Phone:815-353-2601
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-01-25
Last Update Date:2018-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036085984261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036085984Medicaid
IL336.048074OtherCONTROLLED SUBSTANCE LICENSE NUMBER