Provider Demographics
NPI:1851578488
Name:SALAME, GERARD
Entity Type:Individual
Prefix:
First Name:GERARD
Middle Name:
Last Name:SALAME
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:639 W GRACE ST APT 134
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60613-4001
Mailing Address - Country:US
Mailing Address - Phone:703-434-0711
Mailing Address - Fax:
Practice Address - Street 1:639 W GRACE ST APT 134
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60613-4001
Practice Address - Country:US
Practice Address - Phone:703-434-0711
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-25
Last Update Date:2021-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL12505151207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine