MEDICARE: MOHAMED H SALAMI CNP

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
1	363LF0000X	Family Nurse Practitioner	APRN.CNP.0026935	OH

General Provider Information

NPI Number	:	1356952147
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MOHAMED H SALAMI CNP

Provider Business Mailing Address
First Line	:	6892 FOREST RUN DR
Second Line	:
City	:	TEMPERANCE
State	:	MI
Zip	:	48182-1392
Country	:	US
Telephone Number	:	419-508-6706
Fax Number	:

Provider Business Practice Location Address
First Line	:	6135 TRUST DR STE 230
Second Line	:
City	:	HOLLAND
State	:	OH
Zip	:	43528-9360
Country	:	US
Telephone Number	:	567-703-9869
Fax Number	:	419-214-1900

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/14/2020
Last Update Date	:	09/07/2021

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