Provider Demographics
NPI:1154572923
Name:SAM SALITURO INC
Entity type:Organization
Organization Name:SAM SALITURO INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SAM
Authorized Official - Middle Name:
Authorized Official - Last Name:SALITURO
Authorized Official - Suffix:JR
Authorized Official - Credentials:OD
Authorized Official - Phone:847-294-6722
Mailing Address - Street 1:1070 E OAKTON ST
Mailing Address - Street 2:
Mailing Address - City:DES PLAINES
Mailing Address - State:IL
Mailing Address - Zip Code:60018-2033
Mailing Address - Country:US
Mailing Address - Phone:847-294-6722
Mailing Address - Fax:847-294-6822
Practice Address - Street 1:1070 E OAKTON ST
Practice Address - Street 2:
Practice Address - City:DES PLAINES
Practice Address - State:IL
Practice Address - Zip Code:60018-2033
Practice Address - Country:US
Practice Address - Phone:847-294-6722
Practice Address - Fax:847-294-6822
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-09
Last Update Date:2008-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL046008548261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center