Provider Demographics
NPI:1750547030
Name:SALEM, SUHAIL BAKR (MD)
Entity type:Individual
Prefix:DR
First Name:SUHAIL
Middle Name:BAKR
Last Name:SALEM
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 1:12035 WILSHIRE BLVD APT 518
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90025-1278
Mailing Address - Country:US
Mailing Address - Phone:312-404-5440
Mailing Address - Fax:
Practice Address - Street 1:18350 ROSCOE BLVD STE 702
Practice Address - Street 2:
Practice Address - City:NORTHRIDGE
Practice Address - State:CA
Practice Address - Zip Code:91325-4109
Practice Address - Country:US
Practice Address - Phone:818-280-5961
Practice Address - Fax:818-280-5983
Is Sole Proprietor?:No
Enumeration Date:2008-08-05
Last Update Date:2020-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL125.053739207R00000X
NJ25MA09672100207RG0100X
CAA154968207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0470781Medicaid