Provider Demographics
NPI:1003418013
Name:ALFATLAWI, SALEH KADHIM
Entity Type:Individual
Prefix:MR
First Name:SALEH
Middle Name:KADHIM
Last Name:ALFATLAWI
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:167 SANTA CRUZ DR S
Mailing Address - Street 2:
Mailing Address - City:FARGO
Mailing Address - State:ND
Mailing Address - Zip Code:58103-1053
Mailing Address - Country:US
Mailing Address - Phone:701-367-6280
Mailing Address - Fax:
Practice Address - Street 1:167 SANTA CRUZ DR S
Practice Address - Street 2:
Practice Address - City:FARGO
Practice Address - State:ND
Practice Address - Zip Code:58103-1053
Practice Address - Country:US
Practice Address - Phone:701-367-6280
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-13
Last Update Date:2020-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
3747P1801X
ND3747P1801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant