Provider Demographics
NPI:1952821662
Name:SALADA, CULLEN (MD)
Entity Type:Individual
Prefix:
First Name:CULLEN
Middle Name:
Last Name:SALADA
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 1:3800 W MADISON ST
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60624-2312
Mailing Address - Country:US
Mailing Address - Phone:773-826-6600
Mailing Address - Fax:812-461-1057
Practice Address - Street 1:3800 W MADISON ST
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60624-2312
Practice Address - Country:US
Practice Address - Phone:773-826-6600
Practice Address - Fax:812-461-1057
Is Sole Proprietor?:No
Enumeration Date:2017-06-23
Last Update Date:2020-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036152029207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine