Provider Demographics
NPI:1174502975
Name:SALEEM, MOHAMMED A (MD)
Entity type:Individual
Prefix:
First Name:MOHAMMED
Middle Name:A
Last Name:SALEEM
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 1:1000 HOUGHTON AVE
Mailing Address - Street 2:
Mailing Address - City:SAGINAW
Mailing Address - State:MI
Mailing Address - Zip Code:48602-5303
Mailing Address - Country:US
Mailing Address - Phone:989-746-7500
Mailing Address - Fax:
Practice Address - Street 1:1260 N IRISH RD
Practice Address - Street 2:STE C
Practice Address - City:DAVISON
Practice Address - State:MI
Practice Address - Zip Code:48423-2276
Practice Address - Country:US
Practice Address - Phone:810-653-1400
Practice Address - Fax:810-653-1440
Is Sole Proprietor?:No
Enumeration Date:2006-01-11
Last Update Date:2020-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301065968207PE0004X, 208000000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207PE0004XAllopathic & Osteopathic PhysiciansEmergency MedicineEmergency Medical Services
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4825020Medicaid
MI4829931Medicaid
MS065968OtherBLUE CROSS BLUE SHIELD
MI4825010Medicaid
MIB56088097Medicare Oscar/Certification
MI4825020Medicaid