1659366839 NPI number — DR. ANAD K SALEM MD

Table of content: DR. ANAD K SALEM MD (NPI 1659366839)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1659366839 NPI number — DR. ANAD K SALEM MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SALEM
Provider First Name:
ANAD
Provider Middle Name:
K
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MD
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:
1659366839
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/08/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
207 W JACKSON ST
Provider Second Line Business Mailing Address:
SUITE 201
Provider Business Mailing Address City Name:
CARBONDALE
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
62901-1408
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
618-457-2963
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
207 W JACKSON ST
Provider Second Line Business Practice Location Address:
SUITE 201
Provider Business Practice Location Address City Name:
CARBONDALE
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
62901-1408
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
618-457-2963
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
09/14/2005

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: 207P00000X , with the licence number:  036094228 , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207PE0005X , with the licence number: 036094228 , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207Q00000X , with the licence number: 036094228 , 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: 03918782 . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".
  • Identifier: 036094228 , issued by the state of ( IL ) . This identifiers is of the category "MEDICAID".
  • Identifier: P00386496 . This is a "LEGATUS RAILROAD MEDICARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 331692 . This is a "HEALTHLINK" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".
  • Identifier: K27657 . This is a "LEGATUS MEDICARE PIN" identifier . This identifiers is of the category "OTHER".
  • Identifier: L61655 . This is a "MEDICARE PIN SIU PHYS & SURG" identifier . This identifiers is of the category "OTHER".
  • Identifier: 031261 . This is a "HEALTH ALLIANCE MEDICAL" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".
  • Identifier: 080120671 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".
  • Identifier: 256510 . This is a "SIU PHYS & SURG MEDICARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 213567 . This is a "LEGATUS MEDICARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 214881054 . This is a "SIMS IL MEDICARE" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".




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