Healthcare Provider Details

I. General information

NPI: 1588642425
Provider Name (Legal Business Name): WAQAR A SALEEM MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/30/2005
Last Update Date: 11/18/2024
Certification Date: 11/18/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 E CHESTNUT ST BLDG SUITE303
LOUISVILLE KY
40202-1831
US

IV. Provider business mailing address

6801 DIXIE HWY SUITE 130
LOUISVILLE KY
40258-3913
US

V. Phone/Fax

Practice location:
  • Phone: 502-629-5552
  • Fax: 502-629-3132
Mailing address:
  • Phone: 502-957-2084
  • Fax: 502-957-1058

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number35850
License Number StateKY
# 2
Primary TaxonomyY
Taxonomy Code207QH0002X
TaxonomyHospice and Palliative Medicine (Family Medicine) Physician
License Number35850
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: