Provider Demographics
NPI:1023484144
Name:SALIH, LAITH K (MD)
Entity type:Individual
Prefix:
First Name:LAITH
Middle Name:K
Last Name:SALIH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1122 N MONTANA AVE
Mailing Address - Street 2:
Mailing Address - City:HELENA
Mailing Address - State:MT
Mailing Address - Zip Code:59601-3513
Mailing Address - Country:US
Mailing Address - Phone:406-437-2833
Mailing Address - Fax:406-449-4730
Practice Address - Street 1:1122 N MONTANA AVE
Practice Address - Street 2:
Practice Address - City:HELENA
Practice Address - State:MT
Practice Address - Zip Code:59601-3513
Practice Address - Country:US
Practice Address - Phone:406-437-2833
Practice Address - Fax:406-449-4730
Is Sole Proprietor?:Yes
Enumeration Date:2015-08-12
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
MT52503208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT1023484144Medicaid