Provider Demographics
NPI:1548574320
Name:AHMAD SALAMEH, AHMAD MAMDOUH (MBBS)
Entity Type:Individual
Prefix:
First Name:AHMAD
Middle Name:MAMDOUH
Last Name:AHMAD SALAMEH
Suffix:
Gender:M
Credentials:MBBS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:901 MCCLINTOCK DR
Mailing Address - Street 2:STE 202
Mailing Address - City:BURR RIDGE
Mailing Address - State:IL
Mailing Address - Zip Code:60527-0872
Mailing Address - Country:US
Mailing Address - Phone:888-220-6432
Mailing Address - Fax:
Practice Address - Street 1:13055 W MCDOWELL RD STE E109
Practice Address - Street 2:
Practice Address - City:AVONDALE
Practice Address - State:AZ
Practice Address - Zip Code:85392-6457
Practice Address - Country:US
Practice Address - Phone:623-328-7794
Practice Address - Fax:623-328-7932
Is Sole Proprietor?:No
Enumeration Date:2010-08-04
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ50380207RI0200X, 208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ023042Medicaid