Individual
EZZELDIN A SALEH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
301 N 8TH ST STE 4A, SPRINGFIELD, IL 62701-1013
(217) 545-8000
(217) 545-6040
Mailing address
PO BOX 19658, SPRINGFIELD, IL 62794-9658
(217) 545-8000
(217) 545-6040
Taxonomy
Speciality
Code
Description
License number
State
2080P0208X
Pediatric Infectious Diseases Physician
Primary
036-144396
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
036-144396
STATE LICENSE
IL
05
—
1167665
—
LA
Enumeration date
06/11/2005
Last updated
12/09/2020
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