Provider Demographics
NPI:1508871476
Name:SOLOMON, IREN (MD)
Entity Type:Individual
Prefix:
First Name:IREN
Middle Name:
Last Name:SOLOMON
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 1:75 TRENT CT
Mailing Address - Street 2:
Mailing Address - City:BURR RIDGE
Mailing Address - State:IL
Mailing Address - Zip Code:60527-6476
Mailing Address - Country:US
Mailing Address - Phone:630-670-2744
Mailing Address - Fax:
Practice Address - Street 1:75 TRENT CT
Practice Address - Street 2:
Practice Address - City:BURR RIDGE
Practice Address - State:IL
Practice Address - Zip Code:60527-6476
Practice Address - Country:US
Practice Address - Phone:630-670-2744
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-29
Last Update Date:2011-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036107741208000000X
IN99031067A208000000X
IL336071449208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
I61060Medicare UPIN