Provider Demographics
NPI:1194036889
Name:SALEM, BAHEYELDIN M (MD)
Entity Type:Individual
Prefix:DR
First Name:BAHEYELDIN
Middle Name:M
Last Name:SALEM
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 1:2900 THOMAS AVE S
Mailing Address - Street 2:APT # 2230
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55416-4477
Mailing Address - Country:US
Mailing Address - Phone:217-220-4965
Mailing Address - Fax:
Practice Address - Street 1:2900 THOMAS AVE S
Practice Address - Street 2:APT # 2230
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55416-4477
Practice Address - Country:US
Practice Address - Phone:217-220-4965
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-28
Last Update Date:2016-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCMD0406862080P0207X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0207XAllopathic & Osteopathic PhysiciansPediatricsPediatric Hematology-Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
DC1194036889Medicaid