Provider Demographics
NPI:1750643482
Name:SAMO, SALIH (MD)
Entity Type:Individual
Prefix:
First Name:SALIH
Middle Name:
Last Name:SAMO
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 1:338 CUSTER AVE
Mailing Address - Street 2:APT 6
Mailing Address - City:EVANSTON
Mailing Address - State:IL
Mailing Address - Zip Code:60202-3432
Mailing Address - Country:US
Mailing Address - Phone:847-997-9233
Mailing Address - Fax:
Practice Address - Street 1:211 E ONTARIO ST
Practice Address - Street 2:7TH FLOOR
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60611-3468
Practice Address - Country:US
Practice Address - Phone:847-997-9233
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-08
Last Update Date:2023-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2021029490207RG0100X
IL036.133659208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
No207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology