Healthcare Provider Details

I. General information

NPI: 1558185686
Provider Name (Legal Business Name): HANNAH GABRIELLE SALK PA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/14/2024
Last Update Date: 04/15/2026
Certification Date: 04/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8765 LEWIS AVE
TEMPERANCE MI
48182-9300
US

IV. Provider business mailing address

8765 LEWIS AVE
TEMPERANCE MI
48182-9300
US

V. Phone/Fax

Practice location:
  • Phone: 734-847-3802
  • Fax: 734-850-0520
Mailing address:
  • Phone: 734-847-3802
  • Fax: 734-850-0520

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number5601013735
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: