Provider Demographics
NPI:1255345138
Name:AKHTAR, MUHAMMAD SALEEM (MD)
Entity type:Individual
Prefix:
First Name:MUHAMMAD
Middle Name:SALEEM
Last Name:AKHTAR
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 1509
Mailing Address - Street 2:
Mailing Address - City:BANNING
Mailing Address - State:CA
Mailing Address - Zip Code:92220-0011
Mailing Address - Country:US
Mailing Address - Phone:951-849-2526
Mailing Address - Fax:951-849-9107
Practice Address - Street 1:1034 W RAMSEY ST
Practice Address - Street 2:# A
Practice Address - City:BANNING
Practice Address - State:CA
Practice Address - Zip Code:92220-4442
Practice Address - Country:US
Practice Address - Phone:951-849-2526
Practice Address - Fax:951-849-9107
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-28
Last Update Date:2012-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA41586207R00000X, 208000000X, 208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
No208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA41586OtherSTATE LICENSE
CAA41586OtherSTATE LICENSE
CAA29412Medicare UPIN