Healthcare Provider Details

I. General information

NPI: 1780118497
Provider Name (Legal Business Name): SALEM MEDICAL P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/19/2017
Last Update Date: 05/05/2023
Certification Date: 05/05/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

28111 HOOVER RD STE 5
WARREN MI
48093-4153
US

IV. Provider business mailing address

28111 HOOVER RD STE 5A
WARREN MI
48093-4153
US

V. Phone/Fax

Practice location:
  • Phone: 586-854-0098
  • Fax: 248-220-4269
Mailing address:
  • Phone: 586-578-9606
  • Fax: 586-578-9806

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number4301085710
License Number StateMI

VIII. Authorized Official

Name: MRS. FARAH K SALEM
Title or Position: PRESIDENT
Credential: M.D.
Phone: 586-578-9606