Provider Demographics
NPI:1659366839
Name:SALEM, ANAD K (MD)
Entity Type:Individual
Prefix:DR
First Name:ANAD
Middle Name:K
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 1:207 W JACKSON ST
Mailing Address - Street 2:SUITE 201
Mailing Address - City:CARBONDALE
Mailing Address - State:IL
Mailing Address - Zip Code:62901-1408
Mailing Address - Country:US
Mailing Address - Phone:618-457-2963
Mailing Address - Fax:
Practice Address - Street 1:207 W JACKSON ST
Practice Address - Street 2:SUITE 201
Practice Address - City:CARBONDALE
Practice Address - State:IL
Practice Address - Zip Code:62901-1408
Practice Address - Country:US
Practice Address - Phone:618-457-2963
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-14
Last Update Date:2021-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036094228207P00000X, 207PE0005X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No207PE0005XAllopathic & Osteopathic PhysiciansEmergency MedicineUndersea and Hyperbaric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL03918782OtherBLUE CROSS BLUE SHIELD
IL036094228Medicaid
P00386496OtherLEGATUS RAILROAD MEDICARE
IL331692OtherHEALTHLINK
K27657OtherLEGATUS MEDICARE PIN
L61655OtherMEDICARE PIN SIU PHYS & SURG
IL031261OtherHEALTH ALLIANCE MEDICAL
IL080120671OtherRAILROAD MEDICARE
256510OtherSIU PHYS & SURG MEDICARE
213567OtherLEGATUS MEDICARE
IL214881054OtherSIMS IL MEDICARE
IL214881054OtherSIMS IL MEDICARE
256510OtherSIU PHYS & SURG MEDICARE
IL0360942885OtherSIMS - IL MEDICAID