Provider Demographics
NPI:1477058311
Name:BASHIR, MOHAMMAD SALAH (MD)
Entity type:Individual
Prefix:DR
First Name:MOHAMMAD
Middle Name:SALAH
Last Name:BASHIR
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 1:15300 WEST AVE STE 220
Mailing Address - Street 2:
Mailing Address - City:ORLAND PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60462-4508
Mailing Address - Country:US
Mailing Address - Phone:708-349-0747
Mailing Address - Fax:708-349-4551
Practice Address - Street 1:15300 WEST AVE STE 220
Practice Address - Street 2:
Practice Address - City:ORLAND PARK
Practice Address - State:IL
Practice Address - Zip Code:60462-4508
Practice Address - Country:US
Practice Address - Phone:708-349-0747
Practice Address - Fax:708-349-4551
Is Sole Proprietor?:Yes
Enumeration Date:2018-03-23
Last Update Date:2021-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036157757207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty