Healthcare Provider Details

I. General information

NPI: 1497741300
Provider Name (Legal Business Name): MICHAEL S SALESIN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/26/2005
Last Update Date: 06/18/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2300 HAGGERTY RD STE 2070
WEST BLOOMFIELD MI
48323-2184
US

IV. Provider business mailing address

2300 HAGGERTY RD STE 2070
WEST BLOOMFIELD MI
48323-2184
US

V. Phone/Fax

Practice location:
  • Phone: 248-926-2020
  • Fax: 248-926-9020
Mailing address:
  • Phone: 248-926-2020
  • Fax: 248-926-9020

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VG0400X
TaxonomyGynecology Physician
License NumberMS027057
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: