MEDICARE: MICHIGAN HOSPITALISTS, PC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician	5101008983	MI

General Provider Information

NPI Number	:	1497755169
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MICHIGAN HOSPITALISTS, PC

Provider Business Mailing Address
First Line	:	4967 CROOKS RD
Second Line	:	SUITE 120
City	:	TROY
State	:	MI
Zip	:	48098-5801
Country	:	US
Telephone Number	:	248-952-1601
Fax Number	:	248-952-5781

Provider Business Practice Location Address
First Line	:	4967 CROOKS RD
Second Line	:	SUITE 120
City	:	TROY
State	:	MI
Zip	:	48098-5801
Country	:	US
Telephone Number	:	248-952-1601
Fax Number	:	248-952-5781

Authorized Official
Title or Position	:	CEO/OWNER
Name	:	DR. GARY SALEM
Credential	:	D.O.
Telephone Number	:	248-952-1601

Provider Enumeration Date	:	07/26/2005
Last Update Date	:	08/22/2020

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4967 CROOKS RD , STE 130
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Practice Location Address:

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1922092816 — DR. AHMAD ZEIBO M.D.
Practice Location Address:

4967 CROOKS RD , SUITE 130
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