Healthcare Provider Details

I. General information

NPI: 1386631497
Provider Name (Legal Business Name): MICHIGAN HOSPITALISTS, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/04/2005
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4967 CROOKS RD SUITE 120
TROY MI
48098-5801
US

IV. Provider business mailing address

4967 CROOKS RD SUITE 120
TROY MI
48098-5801
US

V. Phone/Fax

Practice location:
  • Phone: 248-952-1601
  • Fax: 248-952-5781
Mailing address:
  • Phone: 248-952-1601
  • Fax: 248-952-5781

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number
License Number State

VIII. Authorized Official

Name: GARY S SALEM
Title or Position: CEO/OWNER
Credential: D.O.
Phone: 248-952-1601