Provider Demographics
NPI:1346546785
Name:SALEM, NIZAR
Entity type:Individual
Prefix:
First Name:NIZAR
Middle Name:
Last Name:SALEM
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:NIZAR
Other - Middle Name:
Other - Last Name:SALEM
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 33269
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85067-3269
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:8280 W WARM SPRINGS RD
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89113-3612
Practice Address - Country:US
Practice Address - Phone:702-492-8592
Practice Address - Fax:702-492-8045
Is Sole Proprietor?:No
Enumeration Date:2011-02-02
Last Update Date:2024-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV14018207R00000X, 208M00000X
UT9410265-1205207R00000X
CODR.0053425207R00000X, 208M00000X
MA286944207R00000X
IDM-13868207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
COP01301932OtherRAILROAD MEDICARE
CO87089700Medicaid
CO334897YL2GMedicare PIN
NVFI099YMedicare PIN