Healthcare Provider Details

I. General information

NPI: 1912790510
Provider Name (Legal Business Name): ACKEEM SALMON
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/27/2025
Last Update Date: 05/27/2025
Certification Date: 05/27/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3111 GRAND RIVER AVE
DETROIT MI
48208-2962
US

IV. Provider business mailing address

14984 ARCHDALE ST
DETROIT MI
48227-1446
US

V. Phone/Fax

Practice location:
  • Phone: 313-848-1407
  • Fax:
Mailing address:
  • Phone: 313-848-1407
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code373H00000X
TaxonomyDay Training/Habilitation Specialist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: