Healthcare Provider Details

I. General information

NPI: 1275158081
Provider Name (Legal Business Name): BILAL SALEEM MUHAMMAD MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/08/2020
Last Update Date: 12/09/2025
Certification Date: 12/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1808 CHARLTON CT
GOSHEN IN
46526-6463
US

IV. Provider business mailing address

1808 CHARLTON CT
GOSHEN IN
46526-6463
US

V. Phone/Fax

Practice location:
  • Phone: 574-533-8420
  • Fax: 574-534-5722
Mailing address:
  • Phone: 574-533-8420
  • Fax: 574-534-5722

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208800000X
TaxonomyUrology Physician
License Number4301515004
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: