1205810694 NPI number — DR. MOHAMAD G SALKA MD FACC

Table of content: DR. MOHAMAD G SALKA MD FACC (NPI 1205810694)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1205810694 NPI number — DR. MOHAMAD G SALKA MD FACC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SALKA
Provider First Name:
MOHAMAD
Provider Middle Name:
G
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MD FACC
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1205810694
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/05/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 636643
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CINCINNATI
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
45263-6643
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
440-989-3801
Provider Business Mailing Address Fax Number:
440-960-0264

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3600 KOLBE RD
Provider Second Line Business Practice Location Address:
SUITE 223
Provider Business Practice Location Address City Name:
LORAIN
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
44053
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
440-989-1800
Provider Business Practice Location Address Fax Number:
440-989-1801
Provider Enumeration Date:
11/30/2005

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207RC0000X , with the licence number:  3539130 , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207RI0011X , with the licence number: 35039130 , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 3025372 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0395219 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".




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