Healthcare Provider Details

I. General information

NPI: 1104385061
Provider Name (Legal Business Name): ABDULBASET M. SALIM MD, MPH
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/19/2019
Last Update Date: 08/10/2022
Certification Date: 08/10/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

205 N EAST AVE
JACKSON MI
49201-1753
US

IV. Provider business mailing address

37595 7 MILE RD STE 340
LIVONIA MI
48152-1003
US

V. Phone/Fax

Practice location:
  • Phone: 517-205-1328
  • Fax:
Mailing address:
  • Phone: 734-793-2470
  • Fax: 734-793-2471

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number4301507195
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: