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General NPI Number Information
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NPI Number | 1063998094
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Entity Type | Individual
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Provider Name | KELSEY LYNN SALAZAR PA-C
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Gender | Female
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Dates
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Enumeration Date | 07/12/2018
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Last Update Date | 05/20/2024
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Provider Practice Location Address
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Address Line | 2799 W GRAND BLVD
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City | DETROIT
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State | MI
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Zip | 48202-2689
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Country | US
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Telephone | 313-916-2500
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Fax |
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Provider Business Mailing Address
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Address Line | 2799 W GRAND BLVD # 5
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City | DETROIT
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State | MI
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Zip | 48202-2608
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Country | US
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Telephone | 313-916-2194
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Fax | 313-916-7911
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 5601010803
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License Number State | MI
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Taxonomy #2
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 085006725
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License Number State | IL
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