Healthcare Provider Details

I. General information

NPI: 1619611472
Provider Name (Legal Business Name): MOHAMMAD SALEHI
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/26/2022
Last Update Date: 07/01/2026
Certification Date: 07/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3990 JOHN R ST
DETROIT MI
48201-2059
US

IV. Provider business mailing address

3990 JOHN R ST
DETROIT MI
48201-2059
US

V. Phone/Fax

Practice location:
  • Phone: 737-932-5036
  • Fax:
Mailing address:
  • Phone: 737-932-5036
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number5951001631
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: