Healthcare Provider Details

I. General information

NPI: 1164582532
Provider Name (Legal Business Name): MOHAMMAD SALEH MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/08/2006
Last Update Date: 07/17/2026
Certification Date: 07/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4309 W MEDICAL CENTER DR STE A102
MCHENRY IL
60050-8436
US

IV. Provider business mailing address

1045 W STEPHENSON ST
FREEPORT IL
61032-4864
US

V. Phone/Fax

Practice location:
  • Phone: 815-338-6600
  • Fax:
Mailing address:
  • Phone: 815-599-6000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number036126816
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number48895
License Number StateWI
# 3
Primary TaxonomyY
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License Number036126816
License Number StateIL
# 4
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number48895
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: