Provider Demographics
NPI:1740784552
Name:SALAZAR, CHRISTINA (DO)
Entity Type:Individual
Prefix:
First Name:CHRISTINA
Middle Name:
Last Name:SALAZAR
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6155 GRAND AVE STE 200
Mailing Address - Street 2:
Mailing Address - City:GURNEE
Mailing Address - State:IL
Mailing Address - Zip Code:60031-1651
Mailing Address - Country:US
Mailing Address - Phone:847-535-7157
Mailing Address - Fax:
Practice Address - Street 1:6155 GRAND AVE STE 200
Practice Address - Street 2:
Practice Address - City:GURNEE
Practice Address - State:IL
Practice Address - Zip Code:60031-1651
Practice Address - Country:US
Practice Address - Phone:847-535-7157
Practice Address - Fax:224-271-3202
Is Sole Proprietor?:No
Enumeration Date:2018-03-19
Last Update Date:2021-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
IL036157582207Q00000X
IL125.072774207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program