Provider Demographics
NPI:1548306178
Name:GABRIEL E SALLOUM MD PA
Entity type:Organization
Organization Name:GABRIEL E SALLOUM MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:KELLI
Authorized Official - Middle Name:
Authorized Official - Last Name:LYSFJORD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-405-6910
Mailing Address - Street 1:2 NE 40TH ST
Mailing Address - Street 2:SUITE 203
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33137-3551
Mailing Address - Country:US
Mailing Address - Phone:305-405-6910
Mailing Address - Fax:305-405-6912
Practice Address - Street 1:2 NE 40TH ST
Practice Address - Street 2:SUITE 203
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33137-3551
Practice Address - Country:US
Practice Address - Phone:305-405-6910
Practice Address - Fax:305-405-6912
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-30
Last Update Date:2011-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME81572173000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes173000000XOther Service ProvidersLegal MedicineGroup - Single Specialty