Provider Demographics
NPI:1538139316
Name:SALEM, MOHAMED MEDHAT (MD)
Entity Type:Individual
Prefix:DR
First Name:MOHAMED
Middle Name:MEDHAT
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 1:2845 N SHERIDAN RD
Mailing Address - Street 2:STE 703
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60657
Mailing Address - Country:US
Mailing Address - Phone:773-525-4701
Mailing Address - Fax:773-326-3539
Practice Address - Street 1:331 W SURF ST STE 703
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60657-7227
Practice Address - Country:US
Practice Address - Phone:773-525-4701
Practice Address - Fax:773-326-3539
Is Sole Proprietor?:No
Enumeration Date:2006-01-25
Last Update Date:2020-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036072417207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036072417Medicaid
ILP00291676OtherRAILROAD MEDICARE
IL01636011OtherBCBS PROVIDER ID
ILP00291676Medicare PIN
IL01636011OtherBCBS PROVIDER ID
ILP00291676OtherRAILROAD MEDICARE