Provider Demographics
NPI:1790989168
Name:MANCHO, SALIM NJI (DO)
Entity Type:Individual
Prefix:
First Name:SALIM
Middle Name:NJI
Last Name:MANCHO
Suffix:
Gender:M
Credentials:DO
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 933432
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44193-0039
Mailing Address - Country:US
Mailing Address - Phone:937-641-3000
Mailing Address - Fax:
Practice Address - Street 1:1 CHILDRENS PLZ
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45404-1873
Practice Address - Country:US
Practice Address - Phone:937-641-4000
Practice Address - Fax:937-641-4500
Is Sole Proprietor?:No
Enumeration Date:2007-06-12
Last Update Date:2023-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH34.0089772086S0122X, 2086S0122X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0122XAllopathic & Osteopathic PhysiciansSurgeryPlastic and Reconstructive Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2768625Medicaid
341966854OtherTRICARE
341966854OtherFAMILY HEALTH PLAN
OHP00088357OtherRAILROAD MEDICARE
01343OtherPARAMOUNT
341966854OtherHUMANA - NWOS
MI5184680OtherMICHIGAN MEDICAID
341966854OtherAETNA
748059OtherBUCKEYE COMMUNITY HEALTH PLAN
341966854OtherCIGNA
OH2768625Medicaid
341966854OtherNATIONWIDE
OH2768625Medicaid
000000531048OtherANTHEM
341966854OtherTRICARE