Provider Demographics
NPI:1154130029
Name:ABDUSSALAAM, KHALID
Entity type:Individual
Prefix:
First Name:KHALID
Middle Name:
Last Name:ABDUSSALAAM
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4192 LEEWOOD RD
Mailing Address - Street 2:
Mailing Address - City:STOW
Mailing Address - State:OH
Mailing Address - Zip Code:44224-2557
Mailing Address - Country:US
Mailing Address - Phone:302-745-9561
Mailing Address - Fax:
Practice Address - Street 1:4192 LEEWOOD RD
Practice Address - Street 2:
Practice Address - City:STOW
Practice Address - State:OH
Practice Address - Zip Code:44224-2557
Practice Address - Country:US
Practice Address - Phone:302-745-9561
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-01-04
Last Update Date:2025-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172A00000XOther Service ProvidersDriver