Provider Demographics
NPI:1134146152
Name:SALTI, NADER I (MD)
Entity Type:Individual
Prefix:
First Name:NADER
Middle Name:I
Last Name:SALTI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1905 HUEBBE PARKWAY
Mailing Address - Street 2:BELOIT CLINIC SC
Mailing Address - City:BELOIT
Mailing Address - State:WI
Mailing Address - Zip Code:53511-1842
Mailing Address - Country:US
Mailing Address - Phone:608-364-2200
Mailing Address - Fax:608-364-2338
Practice Address - Street 1:6015 DURAND AVE
Practice Address - Street 2:SUITE 500
Practice Address - City:RACINE
Practice Address - State:WI
Practice Address - Zip Code:53406-5089
Practice Address - Country:US
Practice Address - Phone:262-554-1919
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-16
Last Update Date:2008-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI41559020174400000X
IL174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI32591800Medicaid
WI32591800Medicaid