Provider Demographics
NPI:1255774477
Name:ABU SALEH, NOUR KHALID (MD)
Entity type:Individual
Prefix:
First Name:NOUR
Middle Name:KHALID
Last Name:ABU SALEH
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2913 BETIN AVE
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:LA
Mailing Address - Zip Code:71201-7257
Mailing Address - Country:US
Mailing Address - Phone:318-388-1250
Mailing Address - Fax:318-388-0948
Practice Address - Street 1:2915 BETIN AVE
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:LA
Practice Address - Zip Code:71201-7257
Practice Address - Country:US
Practice Address - Phone:318-651-9945
Practice Address - Fax:318-322-5141
Is Sole Proprietor?:No
Enumeration Date:2013-04-08
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA3049732080A0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080A0000XAllopathic & Osteopathic PhysiciansPediatricsAdolescent Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA2439715Medicaid