Healthcare Provider Details

I. General information

NPI: 1962588681
Provider Name (Legal Business Name): REINA O SALAZAR MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/27/2006
Last Update Date: 04/01/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

23501 JEFFERSON AVE
SAINT CLAIR SHORES MI
48080-1968
US

IV. Provider business mailing address

21300 KELLY ROAD
EASTPOINTE MI
48021
US

V. Phone/Fax

Practice location:
  • Phone: 586-863-5030
  • Fax: 586-209-3750
Mailing address:
  • Phone: 586-447-4200
  • Fax: 586-447-4208

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2080P0201X
TaxonomyPediatric Allergy/Immunology Physician
License Number4301406855
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code207K00000X
TaxonomyAllergy & Immunology Physician
License Number4301406855
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: