Basic Information
Provider Information
NPI: 1780624940
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: SALAM-KHAN
FirstName: SANOBER
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential: M.D.
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
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Mailing Information
Address1: 520 E 22ND ST
Address2:  
City: LOMBARD
State: IL
PostalCode: 601486110
CountryCode: US
TelephoneNumber: 6308742542
FaxNumber: 6308742642
Practice Location
Address1: OUR LADY OF THE RESURRECTION HOSPITAL
Address2: 5645 W. ADDISON STREET
City: CHICAGO
State: IL
PostalCode: 60634
CountryCode: US
TelephoneNumber: 7732827000
FaxNumber:  
Other Information
ProviderEnumerationDate: 06/07/2006
LastUpdateDate: 07/08/2007
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
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AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: X
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207P00000X ILY Allopathic & Osteopathic PhysiciansEmergency Medicine 

No ID Information.


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