Provider Demographics
NPI:1720812647
Name:SALAH, BASHIR A
Entity type:Individual
Prefix:
First Name:BASHIR
Middle Name:A
Last Name:SALAH
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 1:350 NATHAN LN N UNIT 448
Mailing Address - Street 2:
Mailing Address - City:PLYMOUTH
Mailing Address - State:MN
Mailing Address - Zip Code:55441-6413
Mailing Address - Country:US
Mailing Address - Phone:214-207-1677
Mailing Address - Fax:
Practice Address - Street 1:350 NATHAN LN N UNIT 448
Practice Address - Street 2:
Practice Address - City:PLYMOUTH
Practice Address - State:MN
Practice Address - Zip Code:55441-6413
Practice Address - Country:US
Practice Address - Phone:214-207-1677
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-09-02
Last Update Date:2024-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)