Healthcare Provider Details

I. General information

NPI: 1205839909
Provider Name (Legal Business Name): GARY SHELDON SALEM D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/27/2005
Last Update Date: 07/29/2026
Certification Date: 07/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13137 N CLIO RD
CLIO MI
48420-1028
US

IV. Provider business mailing address

4632 FAWN HILL CT
OAKLAND TWP MI
48306-1677
US

V. Phone/Fax

Practice location:
  • Phone: 313-590-9170
  • Fax: 844-274-3091
Mailing address:
  • Phone: 313-570-9170
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number5101008983
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number5101008983
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: