1538139316 NPI number — DR. MOHAMED MEDHAT SALEM M.D.

Table of content: DR. MOHAMED MEDHAT SALEM M.D. (NPI 1538139316)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1538139316 NPI number — DR. MOHAMED MEDHAT SALEM M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SALEM
Provider First Name:
MOHAMED
Provider Middle Name:
MEDHAT
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.D.
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:
1538139316
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/23/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2845 N SHERIDAN RD
Provider Second Line Business Mailing Address:
STE 703
Provider Business Mailing Address City Name:
CHICAGO
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
60657
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
773-525-4701
Provider Business Mailing Address Fax Number:
773-326-3539

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
331 W SURF ST STE 703
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CHICAGO
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60657-7227
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
773-525-4701
Provider Business Practice Location Address Fax Number:
773-326-3539
Provider Enumeration Date:
01/25/2006

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: 207RN0300X , with the licence number:  036072417 , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 036072417 , issued by the state of ( IL ) . This identifiers is of the category "MEDICAID".
  • Identifier: P00291676 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".
  • Identifier: 01636011 . This is a "BCBS PROVIDER ID" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".