Basic Information
Provider Information | |||||||||
NPI: | 1376626085 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | SALEEM | ||||||||
FirstName: | UMER | ||||||||
MiddleName: |   | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: | M.D. | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | PO BOX 20970 | ||||||||
Address2: |   | ||||||||
City: | CHEYENNE | ||||||||
State: | WY | ||||||||
PostalCode: | 820037020 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 3076371600 | ||||||||
FaxNumber: | 3076371699 | ||||||||
Practice Location | |||||||||
Address1: | 2301 HOUSE AVE STE 301 | ||||||||
Address2: |   | ||||||||
City: | CHEYENNE | ||||||||
State: | WY | ||||||||
PostalCode: | 820013178 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 3076371600 | ||||||||
FaxNumber: | 3076371699 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 10/24/2006 | ||||||||
LastUpdateDate: | 01/07/2022 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | M | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: | 01/07/2022 |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 058582 | GA | N |   | Allopathic & Osteopathic Physicians | Internal Medicine |   | 207RC0000X | 21685 | WI | N |   | Allopathic & Osteopathic Physicians | Internal Medicine | Cardiovascular Disease | 207RC0000X | MD449176 | PA | N |   | Allopathic & Osteopathic Physicians | Internal Medicine | Cardiovascular Disease | 208M00000X | 243842 | MA | N |   | Allopathic & Osteopathic Physicians | Hospitalist |   | 207RC0000X | 11105A | WY | Y |   | Allopathic & Osteopathic Physicians | Internal Medicine | Cardiovascular Disease |
ID Information
ID | Type | State | Issuer | Description | 212402671A | 05 | GA |   | MEDICAID | 212402671B | 05 | GA |   | MEDICAID | 212402671C | 05 | GA |   | MEDICAID | 3137920 | 01 | PA | HIGHMARK | OTHER | 103031504 | 05 | PA |   | MEDICAID | 7578083 | 01 | PA | CIGNA | OTHER |