Healthcare Provider Details

I. General information

NPI: 1811975089
Provider Name (Legal Business Name): KHALEEL SALAHUDEEN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: KHALEELUR RAHMAN SALAHUDEEN M.D.

II. Dates (important events)

Enumeration Date: 01/06/2006
Last Update Date: 01/20/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18731 N. REEMS RD #680
SURPRISE AZ
85374
US

IV. Provider business mailing address

13464 N. 93RD AVE #100
PEORIA AZ
85381
US

V. Phone/Fax

Practice location:
  • Phone: 623-975-0592
  • Fax: 623-975-0750
Mailing address:
  • Phone: 623-933-0301
  • Fax: 623-933-0224

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License Number34909
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: