Basic Information
Provider Information | |||||||||
NPI: | 1083611800 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | SALVINO | ||||||||
FirstName: | KEVIN | ||||||||
MiddleName: | J. | ||||||||
NamePrefix: | DR. | ||||||||
NameSuffix: |   | ||||||||
Credential: | D.P.M. | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: | SALVINO | ||||||||
OtherFirstName: | KEVIN | ||||||||
OtherMiddleName: | J. | ||||||||
OtherNamePrefix: | DR. | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: | DPM | ||||||||
OtherLastNameType: | 2 | ||||||||
Mailing Information | |||||||||
Address1: | 23 W CHICAGO AVE | ||||||||
Address2: |   | ||||||||
City: | HINSDALE | ||||||||
State: | IL | ||||||||
PostalCode: | 605213401 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 6307891700 | ||||||||
FaxNumber: | 6307891748 | ||||||||
Practice Location | |||||||||
Address1: | 23 W CHICAGO AVE | ||||||||
Address2: |   | ||||||||
City: | HINSDALE | ||||||||
State: | IL | ||||||||
PostalCode: | 605213401 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 6307891700 | ||||||||
FaxNumber: | 6307891748 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 07/07/2005 | ||||||||
LastUpdateDate: | 10/05/2012 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | M | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | Y | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 213E00000X | 016-003691 | IL | Y |   | Podiatric Medicine & Surgery Service Providers | Podiatrist |   |
ID Information
ID | Type | State | Issuer | Description | 600-01523 | 01 | IL | BCBS | OTHER | 0806530001 | 01 | IL | DMERC | OTHER |