Healthcare Provider Details

I. General information

NPI: 1205810694
Provider Name (Legal Business Name): MOHAMAD G SALKA MD FACC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/30/2005
Last Update Date: 01/05/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3600 KOLBE RD SUITE 223
LORAIN OH
44053
US

IV. Provider business mailing address

PO BOX 636643
CINCINNATI OH
45263-6643
US

V. Phone/Fax

Practice location:
  • Phone: 440-989-1800
  • Fax: 440-989-1801
Mailing address:
  • Phone: 440-989-3801
  • Fax: 440-960-0264

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number3539130
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code207RI0011X
TaxonomyInterventional Cardiology Physician
License Number35039130
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: