Provider Demographics
NPI:1396284717
Name:HATOUM, SALEH (MD)
Entity type:Individual
Prefix:
First Name:SALEH
Middle Name:
Last Name:HATOUM
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 1:4278 N HAZEL ST APT 4F
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60613-1673
Mailing Address - Country:US
Mailing Address - Phone:847-912-8056
Mailing Address - Fax:
Practice Address - Street 1:327 IL ROUTE 2
Practice Address - Street 2:
Practice Address - City:DIXON
Practice Address - State:IL
Practice Address - Zip Code:61021-9118
Practice Address - Country:US
Practice Address - Phone:815-284-1111
Practice Address - Fax:815-284-2306
Is Sole Proprietor?:No
Enumeration Date:2017-02-17
Last Update Date:2020-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036.1500522085R0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation Oncology