Basic Information
| Provider Information | |||||||||
| NPI: | 1174502975 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SALEEM | ||||||||
| FirstName: | MOHAMMED | ||||||||
| MiddleName: | A | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1000 HOUGHTON AVE | ||||||||
| Address2: | |||||||||
| City: | SAGINAW | ||||||||
| State: | MI | ||||||||
| PostalCode: | 486025303 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9897467500 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1260 N IRISH RD | ||||||||
| Address2: | STE C | ||||||||
| City: | DAVISON | ||||||||
| State: | MI | ||||||||
| PostalCode: | 484232276 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8106531400 | ||||||||
| FaxNumber: | 8106531440 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/11/2006 | ||||||||
| LastUpdateDate: | 08/12/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 08/12/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207PE0004X | 4301065968 | MI | N | Allopathic & Osteopathic Physicians | Emergency Medicine | Emergency Medical Services | 208000000X | 4301065968 | MI | N | Allopathic & Osteopathic Physicians | Pediatrics | 207R00000X | 4301065968 | MI | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
ID Information
| ID | Type | State | Issuer | Description | 4825020 | 05 | MI | MEDICAID | 4829931 | 05 | MI | MEDICAID | MS065968 | 01 | BLUE CROSS BLUE SHIELD | OTHER | 4825010 | 05 | MI | MEDICAID |