Healthcare Provider Details

I. General information

NPI: 1811956139
Provider Name (Legal Business Name): SAMER SALKA M.D
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/23/2006
Last Update Date: 08/03/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15120 MICHIGAN AVE SUITE A
DEARBORN MI
48126-2916
US

IV. Provider business mailing address

6000 HICKORY TREE TRL
BLOOMFIELD MI
48301-1340
US

V. Phone/Fax

Practice location:
  • Phone: 313-624-8417
  • Fax:
Mailing address:
  • Phone: 734-459-7444
  • Fax:

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:
Title or Position:
Credential:
Phone: