Healthcare Provider Details

I. General information

NPI: 1578760898
Provider Name (Legal Business Name): ADAMU SALISU M.D
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/29/2007
Last Update Date: 04/20/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1408 E FRANKLIN ST
MONROE NC
28112-5160
US

IV. Provider business mailing address

1408 E FRANKLIN ST
MONROE NC
28112-5160
US

V. Phone/Fax

Practice location:
  • Phone: 704-635-2080
  • Fax:
Mailing address:
  • Phone: 704-635-2080
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number2005 01681
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: