Provider Demographics
NPI:1740257484
Name:SLOM, TREVOR J (MD)
Entity type:Individual
Prefix:
First Name:TREVOR
Middle Name:J
Last Name:SLOM
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:880 W. CENTRAL RD.
Mailing Address - Street 2:SUITE 8100
Mailing Address - City:ARLINGTON HEIGHTS
Mailing Address - State:IL
Mailing Address - Zip Code:60005
Mailing Address - Country:US
Mailing Address - Phone:847-255-5030
Mailing Address - Fax:847-255-0156
Practice Address - Street 1:880 W. CENTRAL RD.
Practice Address - Street 2:SUITE 8100
Practice Address - City:ARLINGTON HEIGHTS
Practice Address - State:IL
Practice Address - Zip Code:60005
Practice Address - Country:US
Practice Address - Phone:847-255-5030
Practice Address - Fax:847-255-0156
Is Sole Proprietor?:No
Enumeration Date:2006-03-01
Last Update Date:2018-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036-095393207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL0001636111OtherBLUE CROSS BLUE SHIELD OF IL
MO205454606Medicaid
IL036095393Medicaid
IL615318700OtherUS DEPT OF LABOR - 2222 DIVISION, CHICAGO LOCATION
IL615318701OtherUS DEPT OF LABOR-2001 CALIFORNIA, CHICAGO LOCATION
IL036095393Medicaid
IL0001636111OtherBLUE CROSS BLUE SHIELD OF IL
IL1740257484OtherTRICARE
IL213308003Medicare PIN