MEDICARE: DR. MOHAMED MEDHAT SALEM M.D.

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	207RN0300X	Nephrology Physician	036072417	IL

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	P00291676	OTHER	IL	RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	01636011	OTHER	IL	BCBS PROVIDER ID

General Provider Information

NPI Number	:	1538139316
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MOHAMED MEDHAT SALEM M.D.

Provider Business Mailing Address
First Line	:	2845 N SHERIDAN RD
Second Line	:	STE 703
City	:	CHICAGO
State	:	IL
Zip	:	60657
Country	:	US
Telephone Number	:	773-525-4701
Fax Number	:	773-326-3539

Provider Business Practice Location Address
First Line	:	331 W SURF ST STE 703
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60657-7227
Country	:	US
Telephone Number	:	773-525-4701
Fax Number	:	773-326-3539

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

Provider Enumeration Date	:	01/25/2006
Last Update Date	:	03/23/2020

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Directions to “ DR. MOHAMED MEDHAT SALEM M.D.” Practice Location

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