Healthcare Provider Details

I. General information

NPI: 1144257148
Provider Name (Legal Business Name): OWOSSO MEDICAL ASSOCIATES PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/26/2006
Last Update Date: 05/24/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 HEALTH PARK DR. SUITE 304
OWOSSO MI
48867
US

IV. Provider business mailing address

300 HEALTH PARK DR STE 304
OWOSSO MI
48867-1293
US

V. Phone/Fax

Practice location:
  • Phone: 989-729-4222
  • Fax: 989-729-4968
Mailing address:
  • Phone: 989-729-4222
  • Fax: 989-729-4968

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number4301059658
License Number StateMI

VIII. Authorized Official

Name: WAEL J SALMAN
Title or Position: OWNER
Credential: MD
Phone: 989-729-4222