Provider Demographics
NPI:1073518866
Name:SALTER, MICHAEL STEWART (DPM)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:STEWART
Last Name:SALTER
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1460 WALTON BLVD
Mailing Address - Street 2:STE 60
Mailing Address - City:ROCHESTER HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48309-1768
Mailing Address - Country:US
Mailing Address - Phone:248-651-0653
Mailing Address - Fax:248-651-3697
Practice Address - Street 1:1460 WALTON BLVD
Practice Address - Street 2:STE 60
Practice Address - City:ROCHESTER HILLS
Practice Address - State:MI
Practice Address - Zip Code:48309-1768
Practice Address - Country:US
Practice Address - Phone:248-651-0653
Practice Address - Fax:248-651-3697
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-17
Last Update Date:2010-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5901000637213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI10583840Medicaid
MI10583840Medicaid
MI0N40380Medicare ID - Type Unspecified