Healthcare Provider Details

I. General information

NPI: 1194036889
Provider Name (Legal Business Name): BAHEYELDIN M SALEM M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/28/2010
Last Update Date: 06/09/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2900 THOMAS AVE S APT # 2230
MINNEAPOLIS MN
55416-4477
US

IV. Provider business mailing address

2900 THOMAS AVE S APT # 2230
MINNEAPOLIS MN
55416-4477
US

V. Phone/Fax

Practice location:
  • Phone: 217-220-4965
  • Fax:
Mailing address:
  • Phone: 217-220-4965
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080P0207X
TaxonomyPediatric Hematology & Oncology Physician
License NumberMD040686
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: