Healthcare Provider Details

I. General information

NPI: 1841522018
Provider Name (Legal Business Name): GARY SALEM, D.O., PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/12/2010
Last Update Date: 05/09/2023
Certification Date: 05/09/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13137 N CLIO RD
CLIO MI
48420-1028
US

IV. Provider business mailing address

PO BOX 343
GRAND BLANC MI
48480-0343
US

V. Phone/Fax

Practice location:
  • Phone: 810-686-2600
  • Fax:
Mailing address:
  • Phone: 313-590-9170
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number5101008983
License Number StateMI

VIII. Authorized Official

Name: GARY S SALEM
Title or Position: PRESIDENT
Credential: D.O.
Phone: 313-590-9170