Healthcare Provider Details

I. General information

NPI: 1831520212
Provider Name (Legal Business Name): ACCESS AND VASCULAR CARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/10/2013
Last Update Date: 04/10/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10861 W 10 MILE RD
OAK PARK MI
48237-1745
US

IV. Provider business mailing address

10861 W 10 MILE RD
OAK PARK MI
48237-1745
US

V. Phone/Fax

Practice location:
  • Phone: 248-268-1135
  • Fax: 248-268-1191
Mailing address:
  • Phone: 248-268-1135
  • Fax: 248-268-1191

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License NumberNS034670
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License NumberNS034670
License Number StateMI

VIII. Authorized Official

Name: DR. NANDA G SALEM
Title or Position: PRESIDENT
Credential: M.D.
Phone: 248-979-5446