1134146152 NPI number — NADER I SALTI MD

Table of content: NADER I SALTI MD (NPI 1134146152)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1134146152 NPI number — NADER I SALTI MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SALTI
Provider First Name:
NADER
Provider Middle Name:
I
Provider Name Prefix Text:
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:
1134146152
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/17/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1905 HUEBBE PARKWAY
Provider Second Line Business Mailing Address:
BELOIT CLINIC SC
Provider Business Mailing Address City Name:
BELOIT
Provider Business Mailing Address State Name:
WI
Provider Business Mailing Address Postal Code:
53511-1842
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
608-364-2200
Provider Business Mailing Address Fax Number:
608-364-2338

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6015 DURAND AVE
Provider Second Line Business Practice Location Address:
SUITE 500
Provider Business Practice Location Address City Name:
RACINE
Provider Business Practice Location Address State Name:
WI
Provider Business Practice Location Address Postal Code:
53406-5089
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
262-554-1919
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
07/16/2006

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: 174400000X , with the licence number:  41559020 , registered in the state of WI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 174400000X , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 32591800 , issued by the state of ( WI ) . This identifiers is of the category "MEDICAID".




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