Provider Demographics
NPI:1558316281
Name:SOLOMON, SAMUEL (MD)
Entity Type:Individual
Prefix:DR
First Name:SAMUEL
Middle Name:
Last Name:SOLOMON
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 1:103 S GREENLEAF ST
Mailing Address - Street 2:SUITE J
Mailing Address - City:GURNEE
Mailing Address - State:IL
Mailing Address - Zip Code:60031-3380
Mailing Address - Country:US
Mailing Address - Phone:847-662-8201
Mailing Address - Fax:847-662-8215
Practice Address - Street 1:103 S GREENLEAF ST
Practice Address - Street 2:SUITE J
Practice Address - City:GURNEE
Practice Address - State:IL
Practice Address - Zip Code:60031-3380
Practice Address - Country:US
Practice Address - Phone:847-662-8201
Practice Address - Fax:847-662-8215
Is Sole Proprietor?:No
Enumeration Date:2006-05-23
Last Update Date:2008-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL36039961174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL6945148002OtherCIGNA
ILK39549OtherMEDICARE INDIVIDUAL NO.
IL1609827237OtherGROUP NPI
IL4044905OtherAETNA
WI89-101OtherWISCONSIN PROVIDER
ILO4920144OtherBCBS
IL1609827237OtherGROUP NPI
IL6945148002OtherCIGNA