Provider Demographics
NPI:1285909481
Name:SALAH, AHMAD MUHAMMAD (DO)
Entity type:Individual
Prefix:
First Name:AHMAD
Middle Name:MUHAMMAD
Last Name:SALAH
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9331 S THOMAS AVE
Mailing Address - Street 2:
Mailing Address - City:BRIDGEVIEW
Mailing Address - State:IL
Mailing Address - Zip Code:60455-2163
Mailing Address - Country:US
Mailing Address - Phone:708-818-7550
Mailing Address - Fax:855-820-7118
Practice Address - Street 1:118 E 90TH DR
Practice Address - Street 2:
Practice Address - City:MERRILLVILLE
Practice Address - State:IN
Practice Address - Zip Code:46410-7160
Practice Address - Country:US
Practice Address - Phone:219-736-2922
Practice Address - Fax:855-820-7118
Is Sole Proprietor?:No
Enumeration Date:2012-03-21
Last Update Date:2024-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036.136451207R00000X, 207RR0500X
IN02005095A207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN300004525Medicaid