Healthcare Provider Details

I. General information

NPI: 1659366839
Provider Name (Legal Business Name): ANAD K SALEM MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/14/2005
Last Update Date: 08/28/2025
Certification Date: 07/30/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

207 W JACKSON ST SUITE 201
CARBONDALE IL
62901-1408
US

IV. Provider business mailing address

207 W JACKSON ST SUITE 201
CARBONDALE IL
62901-1408
US

V. Phone/Fax

Practice location:
  • Phone: 618-457-2963
  • Fax:
Mailing address:
  • Phone: 618-457-2963
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number036094228
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code207PE0005X
TaxonomyUndersea and Hyperbaric Medicine (Emergency Medicine) Physician
License Number036094228
License Number StateIL
# 3
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number036094228
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: