Healthcare Provider Details

I. General information

NPI: 1407239791
Provider Name (Legal Business Name): MOHANAD SALEH M.D
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/04/2015
Last Update Date: 08/19/2022
Certification Date: 08/17/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1200 E MICHIGAN AVE STE 700
LANSING MI
48912-1837
US

IV. Provider business mailing address

1200 E MICHIGAN AVE STE 700
LANSING MI
48912-1837
US

V. Phone/Fax

Practice location:
  • Phone: 517-364-5550
  • Fax: 517-364-5549
Mailing address:
  • Phone: 517-364-5550
  • Fax: 517-364-5549

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RC0200X
TaxonomyCritical Care Medicine (Internal Medicine) Physician
License Number4301505843
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License Number4301505843
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: