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NPI Code Detail

MEDICARE: MOATAZ SALAH

MEDICARE: MOATAZ SALAH
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1122300000XDentist019031474IL

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1215436498
Entity Type Code : Individual
Provider Name (Legal Business Name) : MOATAZ SALAH
Provider Business Mailing Address
First Line : 5836 S HARLEM AVE STE 200
Second Line :
City : SUMMIT
State : IL
Zip : 60501-1407
Country : US
Telephone Number : 708-215-4000
Fax Number :
Provider Business Practice Location Address
First Line : 5540 WALNUT AVE APT 14C
Second Line :
City : DOWNERS GROVE
State : IL
Zip : 60515-4127
Country : US
Telephone Number : 661-916-9850
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/02/2018
Last Update Date : 11/20/2019

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Directions to “ MOATAZ SALAH ” Practice Location

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