Provider Demographics
NPI:1437175379
Name:SALEEMI, MUDASSIR MUBEEN (MD)
Entity Type:Individual
Prefix:
First Name:MUDASSIR
Middle Name:MUBEEN
Last Name:SALEEMI
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 1:2109 S 8TH ST
Mailing Address - Street 2:
Mailing Address - City:TUCUMCARI
Mailing Address - State:NM
Mailing Address - Zip Code:88401-3752
Mailing Address - Country:US
Mailing Address - Phone:505-461-7818
Mailing Address - Fax:
Practice Address - Street 1:1302 E MAIN ST
Practice Address - Street 2:
Practice Address - City:TUCUMCARI
Practice Address - State:NM
Practice Address - Zip Code:88401-2508
Practice Address - Country:US
Practice Address - Phone:505-461-2200
Practice Address - Fax:505-461-2213
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM2002-0500207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM201041750OtherPRESBYTERIAN HEALTH PLAN
NM2301264OtherUNITED HEALTHCARE
NMNM009J24OtherBLUE CROSS BLUE SHIELD,NM
NM10005148OtherLOVELACE,NM
NM39972364Medicaid
NM740OtherMOLINA,NM
NM2301264OtherUNITED HEALTHCARE
H96313Medicare UPIN