Healthcare Provider Details

I. General information

NPI: 1366613713
Provider Name (Legal Business Name): DHAFER S. SALAMA M.D. P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/13/2008
Last Update Date: 03/19/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11446 E 13 MILE RD SUITE A
WARREN MI
48093-6571
US

IV. Provider business mailing address

11446 E 13 MILE RD SUITE A
WARREN MI
48093-6571
US

V. Phone/Fax

Practice location:
  • Phone: 586-574-0222
  • Fax:
Mailing address:
  • Phone: 586-574-0222
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207YX0905X
TaxonomyOtolaryngology/Facial Plastic Surgery Physician
License NumberDS043124
License Number StateMI

VIII. Authorized Official

Name: DR. DHAFER S SALAMA
Title or Position: PHYSICIAN/PRESIDENT
Credential: M.D.
Phone: 586-574-0222