Provider Demographics
NPI:1063517035
Name:KASSAM, SALIM (MD)
Entity type:Individual
Prefix:
First Name:SALIM
Middle Name:
Last Name:KASSAM
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 1:1756 SIBLEY BLVD
Mailing Address - Street 2:
Mailing Address - City:CALUMET CITY
Mailing Address - State:IL
Mailing Address - Zip Code:60409-2215
Mailing Address - Country:US
Mailing Address - Phone:708-730-3900
Mailing Address - Fax:773-637-2006
Practice Address - Street 1:1756 SIBLEY BLVD
Practice Address - Street 2:
Practice Address - City:CALUMET CITY
Practice Address - State:IL
Practice Address - Zip Code:60409-2215
Practice Address - Country:US
Practice Address - Phone:708-730-3900
Practice Address - Fax:773-637-2006
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-14
Last Update Date:2008-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL01605103OtherBLUE SHIELD OF IL
IL01605103OtherBLUE SHIELD OF IL
IL743761Medicare PIN