Provider Demographics
NPI:1194738757
Name:SAKLAYEN, MOHAMMAD GOLAM (MD)
Entity type:Individual
Prefix:DR
First Name:MOHAMMAD
Middle Name:GOLAM
Last Name:SAKLAYEN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10351 YELLOW LOCUST LN
Mailing Address - Street 2:
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45458-9470
Mailing Address - Country:US
Mailing Address - Phone:937-885-7742
Mailing Address - Fax:937-267-7689
Practice Address - Street 1:4100 W 3RD ST
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45428-9000
Practice Address - Country:US
Practice Address - Phone:937-268-6511
Practice Address - Fax:937-267-7689
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-14
Last Update Date:2010-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35 046160207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2217765Medicaid
OHG62753Medicare UPIN
OH2217765Medicaid