Healthcare Provider Details

I. General information

NPI: 1659883320
Provider Name (Legal Business Name): HUSSAM SALEH MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/02/2017
Last Update Date: 05/08/2023
Certification Date: 05/08/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 HOSPITAL DR
COLUMBIA MO
65201-5276
US

IV. Provider business mailing address

13013 FULLER AVE STE A
GRANDVIEW MO
64030-2687
US

V. Phone/Fax

Practice location:
  • Phone: 573-882-2121
  • Fax:
Mailing address:
  • Phone: 816-214-5548
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number2017033426
License Number StateMO
# 2
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number2023016866
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: