Provider Demographics
NPI:1033326970
Name:GHAITH, SALEH ALI (MD)
Entity Type:Individual
Prefix:DR
First Name:SALEH
Middle Name:ALI
Last Name:GHAITH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13575 LESURE ST
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48227-3131
Mailing Address - Country:US
Mailing Address - Phone:313-493-4410
Mailing Address - Fax:313-493-4415
Practice Address - Street 1:13575 LESURE ST
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48227-3131
Practice Address - Country:US
Practice Address - Phone:313-493-4410
Practice Address - Fax:313-493-4415
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-17
Last Update Date:2021-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI53040012122083A0300X
MI4301084363207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2083A0300XAllopathic & Osteopathic PhysiciansPreventive MedicineAddiction MedicineGroup - Single Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0P50870001Medicare PIN