Healthcare Provider Details

I. General information

NPI: 1083854095
Provider Name (Legal Business Name): PREMIER CARDIOVASCULAR SPECIALISTS PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/03/2009
Last Update Date: 12/17/2021
Certification Date: 12/17/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20200 OUTER DR
DEARBORN MI
48124-2634
US

IV. Provider business mailing address

20200 OUTER DR
DEARBORN MI
48124-2634
US

V. Phone/Fax

Practice location:
  • Phone: 313-624-8417
  • Fax: 313-357-7074
Mailing address:
  • Phone: 313-624-8417
  • Fax: 313-357-7074

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License NumberSS051535
License Number StateMI

VIII. Authorized Official

Name: SAMER SALKA
Title or Position: PRESIDENT
Credential: M.D.
Phone: 734-459-7444