Healthcare Provider Details

I. General information

NPI: 1043205222
Provider Name (Legal Business Name): NABIL SALEH M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/14/2005
Last Update Date: 02/04/2021
Certification Date: 01/19/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1111 SUPERIOR ST STE 412
MELROSE PARK IL
60160
US

IV. Provider business mailing address

1419 W LAKE ST STE D
MELROSE PARK IL
60160-3930
US

V. Phone/Fax

Practice location:
  • Phone: 708-450-0112
  • Fax: 708-450-9038
Mailing address:
  • Phone: 708-450-0112
  • Fax: 708-450-9038

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number036058414
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: