Provider Demographics
NPI:1942430855
Name:MIDWEST GERIATRICS
Entity Type:Organization
Organization Name:MIDWEST GERIATRICS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:WAQAR
Authorized Official - Middle Name:
Authorized Official - Last Name:SALEEM
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:502-543-9124
Mailing Address - Street 1:802 OVERHILL DR
Mailing Address - Street 2:
Mailing Address - City:SHEPHERDSVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40165-7252
Mailing Address - Country:US
Mailing Address - Phone:502-543-9124
Mailing Address - Fax:502-543-0844
Practice Address - Street 1:802 OVERHILL DR
Practice Address - Street 2:
Practice Address - City:SHEPHERDSVILLE
Practice Address - State:KY
Practice Address - Zip Code:40165-7252
Practice Address - Country:US
Practice Address - Phone:502-543-9124
Practice Address - Fax:502-543-0844
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-07-27
Last Update Date:2016-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
207Q00000X, 363LF0000X
KY363LA2200X, 363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
No363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult HealthGroup - Single Specialty
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty
No363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY11187Medicare PIN
IN264060Medicare PIN