Healthcare Provider Details

I. General information

NPI: 1861643157
Provider Name (Legal Business Name): GREGORY HAROLD SALMI M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/05/2008
Last Update Date: 10/05/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4516 EDINA BLVD
EDINA MN
55424-1134
US

IV. Provider business mailing address

4516 EDINA BLVD
EDINA MN
55424-1134
US

V. Phone/Fax

Practice location:
  • Phone: 612-616-3374
  • Fax:
Mailing address:
  • Phone: 612-616-3374
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QA0505X
TaxonomyAdult Medicine Physician
License Number20900
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: