Healthcare Provider Details

I. General information

NPI: 1184911612
Provider Name (Legal Business Name): TAIMUR SALEEM MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/05/2011
Last Update Date: 08/27/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

971 LAKELAND DR STE 401
JACKSON MS
39216-4607
US

IV. Provider business mailing address

GONDA GOLDSCHMIED VASCULAR CTR 200 UCLA MEDICAL PLAZA, SUITE 526
LOS ANGELES CA
90095-0001
US

V. Phone/Fax

Practice location:
  • Phone: 601-939-4230
  • Fax: 601-664-6694
Mailing address:
  • Phone: 310-825-8778
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License Number25790
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: