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NPI Code Detail

MEDICARE: EZZELDIN A SALEH MD

MEDICARE: EZZELDIN A SALEH MD
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
12080P0208XPediatric Infectious Diseases Physician036-144396IL

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1036-144396OTHERILSTATE LICENSE
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1417951971
Entity Type Code : Individual
Provider Name (Legal Business Name) : EZZELDIN A SALEH MD
Provider Business Mailing Address
First Line : PO BOX 19658
Second Line :
City : SPRINGFIELD
State : IL
Zip : 62794-9658
Country : US
Telephone Number : 217-545-8000
Fax Number : 217-545-6040
Provider Business Practice Location Address
First Line : 301 N 8TH ST STE 4A
Second Line :
City : SPRINGFIELD
State : IL
Zip : 62701-1013
Country : US
Telephone Number : 217-545-8000
Fax Number : 217-545-6040
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/11/2005
Last Update Date : 12/09/2020

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Directions to “ EZZELDIN A SALEH MD” Practice Location

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