NPIMap

Organization Active NPI

Susana Salcedo MD LLC

  • Internal Medicine Physician
  • Park Ridge, IL
National Provider Identifier
1366748097
Registry record updated Mar 24, 2011
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Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
036120503 Issued in IL
Legal business name
SUSANA SALCEDO MD LLC
Practice address
1600 W Dempster St Ste 120
Park Ridge, IL 60068-1171
Phone
(847) 299-7784
NPI assigned
Jan 27, 2011
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 24, 2011

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Dr. Susana Salcedo, MD
Title
President
Phone
(847) 299-7784

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207R00000X 036120503 IL Primary

Addresses

Primary practice location

1600 W Dempster St Ste 120
Park Ridge, IL 60068-1171

Mailing address

1600 W Dempster St Ste 120
Park Ridge, IL 60068-1171
Phone (847) 299-7784

Other identifiers 1

IdentifierTypeStateIssuer
036120503MedicaidIL

National Provider Directory

National Provider Directory

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1296086400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1300924800000",
    "number": "1366748097",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1600 W DEMPSTER ST STE 120",
            "city": "PARK RIDGE",
            "state": "IL",
            "postal_code": "600681171",
            "telephone_number": "847-299-7784"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1600 W DEMPSTER ST STE 120",
            "city": "PARK RIDGE",
            "state": "IL",
            "postal_code": "600681171",
            "telephone_number": "847-299-7784"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SUSANA SALCEDO MD LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-01-27",
        "last_updated": "2011-03-24",
        "status": "A",
        "authorized_official_last_name": "SALCEDO",
        "authorized_official_first_name": "SUSANA",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "847-299-7784",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Internal Medicine",
            "state": "IL",
            "license": "036120503",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "036120503",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Park Ridge, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 24, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.