Provider Demographics
NPI:1568620276
Name:MAMDANI, SALMAN (DO)
Entity Type:Individual
Prefix:
First Name:SALMAN
Middle Name:
Last Name:MAMDANI
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:353 N DESPLAINES ST
Mailing Address - Street 2:APT 3305
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60661-1234
Mailing Address - Country:US
Mailing Address - Phone:305-766-4061
Mailing Address - Fax:
Practice Address - Street 1:2800 W 95TH ST
Practice Address - Street 2:
Practice Address - City:EVERGREEN PARK
Practice Address - State:IL
Practice Address - Zip Code:60805-2701
Practice Address - Country:US
Practice Address - Phone:708-229-5600
Practice Address - Fax:248-967-7794
Is Sole Proprietor?:No
Enumeration Date:2008-05-29
Last Update Date:2021-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5101017622207P00000X
IL036129939207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine