Provider Demographics
NPI:1942242698
Name:SALERNO, GIOVANNI M (MD)
Entity Type:Individual
Prefix:DR
First Name:GIOVANNI
Middle Name:M
Last Name:SALERNO
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:PO BOX 54
Mailing Address - Street 2:
Mailing Address - City:BOURBONNAIS
Mailing Address - State:IL
Mailing Address - Zip Code:60914-0054
Mailing Address - Country:US
Mailing Address - Phone:815-933-7900
Mailing Address - Fax:815-733-7090
Practice Address - Street 1:461 BROWN BLVD
Practice Address - Street 2:
Practice Address - City:BOURBONNAIS
Practice Address - State:IL
Practice Address - Zip Code:60914-2322
Practice Address - Country:US
Practice Address - Phone:715-933-7900
Practice Address - Fax:815-933-7090
Is Sole Proprietor?:No
Enumeration Date:2006-06-10
Last Update Date:2023-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2009-01826208600000X
CAA45217208600000X
WI63861-20208600000X
IL036 093060208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILP00188249OtherRAILROAD MEDICARE
IL04622763OtherBCBS
IL036093060Medicaid
IL036093060Medicaid
ILK01971Medicare PIN