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General NPI Number Information
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NPI Number | 1003805953
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Entity Type | Individual
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Provider Name | SALEM MICHAEL GEORGE JR. MD
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Gender | Male
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Dates
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Enumeration Date | 10/13/2005
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Last Update Date | 03/01/2024
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Provider Practice Location Address
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Address Line | 4003 KRESGE WAY SUITE 300
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City | LOUISVILLE
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State | KY
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Zip | 40207-4652
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Country | US
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Telephone | 502-897-5139
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Fax | 502-896-6218
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Provider Business Mailing Address
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Address Line | 5200 COMMERCE CROSSINGS DR FL 3
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City | LOUISVILLE
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State | KY
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Zip | 40229-2182
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Country | US
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Telephone | 22-534-9245
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Fax | 502-489-5750
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2086S0129X
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Taxonomy Name | Vascular Surgery Physician
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License Number | 24149
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License Number State | KY
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