Provider Demographics
NPI:1588832810
Name:MANAV K. SALWAN MD SC
Entity Type:Organization
Organization Name:MANAV K. SALWAN MD SC
Other - Org Name:ADVANCED INTERNAL MEDICINE OF NORTHERN ILLINOIS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHYSICIAN/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MANAV
Authorized Official - Middle Name:K
Authorized Official - Last Name:SALWAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:815-758-4189
Mailing Address - Street 1:2540 HAUSER-ROSS DRIVE
Mailing Address - Street 2:SUITE 275
Mailing Address - City:SYCAMORE
Mailing Address - State:IL
Mailing Address - Zip Code:60178-3178
Mailing Address - Country:US
Mailing Address - Phone:815-758-4189
Mailing Address - Fax:815-758-4953
Practice Address - Street 1:2540 HAUSER-ROSS DRIVE
Practice Address - Street 2:SUITE 275
Practice Address - City:SYCAMORE
Practice Address - State:IL
Practice Address - Zip Code:60178-3178
Practice Address - Country:US
Practice Address - Phone:815-758-4189
Practice Address - Fax:815-758-4953
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-20
Last Update Date:2009-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036116971207R00000X
IL036-116971207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036116971Medicaid
IL216626Medicare PIN
IL216625Medicare PIN