Healthcare Provider Details

I. General information

NPI: 1689767543
Provider Name (Legal Business Name): KHALED SALEH M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/02/2006
Last Update Date: 02/10/2022
Certification Date: 02/10/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

45 MOONBOW PLZ
CORBIN KY
40701
US

IV. Provider business mailing address

2700 STANLEY GAULT PKWY STE 129
LOUISVILLE KY
40223-5176
US

V. Phone/Fax

Practice location:
  • Phone: 606-523-9010
  • Fax:
Mailing address:
  • Phone: 502-253-4900
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License Number36456
License Number StateKY
# 2
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number36456
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: