Healthcare Provider Details

I. General information

NPI: 1124737689
Provider Name (Legal Business Name): MAGDANAH SALOMA ISRAEL
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/22/2022
Last Update Date: 05/09/2025
Certification Date: 05/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14030 MINOCK DR
REDFORD MI
48239-2935
US

IV. Provider business mailing address

14030 MINOCK DR
REDFORD MI
48239-2935
US

V. Phone/Fax

Practice location:
  • Phone: 586-420-0026
  • Fax:
Mailing address:
  • Phone: 586-420-0026
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code374J00000X
TaxonomyDoula
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code176B00000X
TaxonomyMidwife
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: