Provider Demographics
NPI:1477699395
Name:SILVA, MARIO E (MD)
Entity Type:Individual
Prefix:DR
First Name:MARIO
Middle Name:E
Last Name:SILVA
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 1:3111 W ARMITAGE AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60647-3818
Mailing Address - Country:US
Mailing Address - Phone:773-394-5260
Mailing Address - Fax:773-394-5271
Practice Address - Street 1:3109 W ARMITAGE AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60647-3818
Practice Address - Country:US
Practice Address - Phone:773-384-4933
Practice Address - Fax:773-384-5037
Is Sole Proprietor?:No
Enumeration Date:2007-01-29
Last Update Date:2013-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036048103207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL0360481032Medicaid
ILD13048Medicare UPIN
IL489511Medicare ID - Type Unspecified