Healthcare Provider Details

I. General information

NPI: 1285909481
Provider Name (Legal Business Name): AHMAD MUHAMMAD SALAH D.O
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/21/2012
Last Update Date: 10/28/2024
Certification Date: 10/28/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

118 E 90TH DR
MERRILLVILLE IN
46410-7160
US

IV. Provider business mailing address

9331 S THOMAS AVE
BRIDGEVIEW IL
60455-2163
US

V. Phone/Fax

Practice location:
  • Phone: 219-736-2922
  • Fax: 855-820-7118
Mailing address:
  • Phone: 708-818-7550
  • Fax: 855-820-7118

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number036.136451
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code207RR0500X
TaxonomyRheumatology Physician
License Number036.136451
License Number StateIL
# 3
Primary TaxonomyY
Taxonomy Code207RR0500X
TaxonomyRheumatology Physician
License Number02005095A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: