Provider Demographics
NPI:1184362873
Name:SALAAD, ABDIRASHID MOHAMED
Entity type:Individual
Prefix:
First Name:ABDIRASHID
Middle Name:MOHAMED
Last Name:SALAAD
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:921 W LAPHAM BLVD APT 12
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53204-3435
Mailing Address - Country:US
Mailing Address - Phone:414-628-3376
Mailing Address - Fax:
Practice Address - Street 1:921 W LAPHAM BLVD APT 12
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53204-3435
Practice Address - Country:US
Practice Address - Phone:414-628-3376
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-05-23
Last Update Date:2022-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WIS4300138600107171W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171W00000XOther Service ProvidersContractorGroup - Single Specialty