Provider Demographics
NPI:1417914474
Name:ABU SALAH, TAREQ M (MD)
Entity Type:Individual
Prefix:DR
First Name:TAREQ
Middle Name:M
Last Name:ABU SALAH
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:1705 EAST BROADWAY
Mailing Address - Street 2:SUITE 280
Mailing Address - City:COLUMBIA
Mailing Address - State:MO
Mailing Address - Zip Code:65201-7185
Mailing Address - Country:US
Mailing Address - Phone:573-815-7118
Mailing Address - Fax:573-815-7116
Practice Address - Street 1:1705 EAST BROADWAY
Practice Address - Street 2:SUITE 280
Practice Address - City:COLUMBIA
Practice Address - State:MO
Practice Address - Zip Code:65201-7185
Practice Address - Country:US
Practice Address - Phone:573-815-7118
Practice Address - Fax:573-815-7116
Is Sole Proprietor?:No
Enumeration Date:2006-04-26
Last Update Date:2020-07-22
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MO2009010821207RP1001X
IA35391207R00000X
MN55532207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO200008188Medicaid