Provider Demographics
NPI:1679677678
Name:MAHMOOD, SALEEM (MD)
Entity Type:Individual
Prefix:
First Name:SALEEM
Middle Name:
Last Name:MAHMOOD
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:PO BOX 483
Mailing Address - Street 2:
Mailing Address - City:LITCHFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:62056-0483
Mailing Address - Country:US
Mailing Address - Phone:217-324-1100
Mailing Address - Fax:217-324-1103
Practice Address - Street 1:1201 E UNION AVE
Practice Address - Street 2:
Practice Address - City:LITCHFIELD
Practice Address - State:IL
Practice Address - Zip Code:62056-1700
Practice Address - Country:US
Practice Address - Phone:217-324-1100
Practice Address - Fax:217-324-1103
Is Sole Proprietor?:No
Enumeration Date:2006-09-11
Last Update Date:2023-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIMD-145092085R0001X
MOR5P722085R0001X
IL0360912472085R0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036091247Medicaid