Provider Demographics
NPI:1992751739
Name:SALEH, MOHAMMAD (MD)
Entity type:Individual
Prefix:
First Name:MOHAMMAD
Middle Name:
Last Name:SALEH
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 1:245 STATE ST SE
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49503-4328
Mailing Address - Country:US
Mailing Address - Phone:616-685-1808
Mailing Address - Fax:616-685-1850
Practice Address - Street 1:1471 E BELTLINE AVE NE
Practice Address - Street 2:STE 201
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49525-4548
Practice Address - Country:US
Practice Address - Phone:616-685-8620
Practice Address - Fax:616-447-7674
Is Sole Proprietor?:No
Enumeration Date:2006-05-25
Last Update Date:2009-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301062078207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI3362934Medicaid
MI4877358Medicaid
MI4877868Medicaid
MI3462180Medicaid
MI3494737Medicaid
MIM02830107Medicare ID - Type Unspecified
MIP32930139Medicare ID - Type Unspecified
MI4877358Medicaid
MI4877868Medicaid