Healthcare Provider Details

I. General information

NPI: 1194738757
Provider Name (Legal Business Name): MOHAMMAD GOLAM SAKLAYEN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/14/2006
Last Update Date: 01/13/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4100 W 3RD ST
DAYTON OH
45428-9000
US

IV. Provider business mailing address

10351 YELLOW LOCUST LN
DAYTON OH
45458-9470
US

V. Phone/Fax

Practice location:
  • Phone: 937-268-6511
  • Fax: 937-267-7689
Mailing address:
  • Phone: 937-885-7742
  • Fax: 937-267-7689

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License Number35 046160
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: