Provider Demographics
NPI:1639106396
Name:SALES, REMEDIOS M (MD)
Entity Type:Individual
Prefix:
First Name:REMEDIOS
Middle Name:M
Last Name:SALES
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 1:11101 S STATE ST
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60628-4206
Mailing Address - Country:US
Mailing Address - Phone:773-821-7515
Mailing Address - Fax:773-821-6970
Practice Address - Street 1:11101 S STATE ST
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60628-4206
Practice Address - Country:US
Practice Address - Phone:773-821-7515
Practice Address - Fax:773-821-6970
Is Sole Proprietor?:No
Enumeration Date:2006-06-27
Last Update Date:2010-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036045713207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036045713Medicaid
IL036045713Medicaid
IL464520Medicare ID - Type Unspecified