Healthcare Provider Details

I. General information

NPI: 1043360431
Provider Name (Legal Business Name): MICHAEL CONRAD SALMI CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/10/2007
Last Update Date: 01/12/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 CAMPUS DR
HANCOCK MI
49930-1569
US

IV. Provider business mailing address

1010 ELM ST
HANCOCK MI
49930-1512
US

V. Phone/Fax

Practice location:
  • Phone: 906-483-1000
  • Fax:
Mailing address:
  • Phone: 906-482-1873
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number4704197570
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: