Provider Demographics
NPI:1972814705
Name:SALVINO PLASTIC SURGERY MD SC
Entity Type:Organization
Organization Name:SALVINO PLASTIC SURGERY MD SC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:SALVINO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:630-929-6565
Mailing Address - Street 1:PO BOX 99
Mailing Address - Street 2:
Mailing Address - City:HINSDALE
Mailing Address - State:IL
Mailing Address - Zip Code:60522-0099
Mailing Address - Country:US
Mailing Address - Phone:630-929-6565
Mailing Address - Fax:708-423-2305
Practice Address - Street 1:6311 W 95TH ST
Practice Address - Street 2:THE CENTER FOR RECONSTRUCTIVE SURGERY
Practice Address - City:OAK LAWN
Practice Address - State:IL
Practice Address - Zip Code:60453-2201
Practice Address - Country:US
Practice Address - Phone:630-929-6565
Practice Address - Fax:708-423-2305
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-06-25
Last Update Date:2011-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036113600208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic SurgeryGroup - Single Specialty