Healthcare Provider Details

I. General information

NPI: 1629842703
Provider Name (Legal Business Name): QUSSAI SALAMAH PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/09/2023
Last Update Date: 11/09/2023
Certification Date: 11/09/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3990 JOHN R ST
DETROIT MI
48201-2018
US

IV. Provider business mailing address

3990 JOHN R ST
DETROIT MI
48201-2018
US

V. Phone/Fax

Practice location:
  • Phone: 248-619-6283
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License Number
License Number State

VIII. Authorized Official

Name: QUSSAI SALAMAH
Title or Position: OWNER
Credential: MD
Phone: 248-619-6283