Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 204D00000X | Neuromusculoskeletal Medicine (NMM) | 35 088916 | OH |
N | 207R00000X | Internist | 43925 | WI |
N | 111NI0900X | Internist | 43925 | WI |
NPI | 1548543069 |
---|---|
Provider Name | Dr. Yasser Salam |
First Address | Avon, OH 44011-2048 |
Second Address | Avon, OH 44011-2048 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 21/09/2011 |
Last Update Date | 09/08/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
000465210 | (05) | WI |
AB04406 | MEDICARE PROVIDER NUMBER (01) | WA |
F93881 | (02) | WA |
F93881 | (02) | WI |