Provider Demographics
NPI:1083854095
Name:PREMIER CARDIOVASCULAR SPECIALISTS PC
Entity Type:Organization
Organization Name:PREMIER CARDIOVASCULAR SPECIALISTS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:SAMER
Authorized Official - Middle Name:
Authorized Official - Last Name:SALKA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:734-459-7444
Mailing Address - Street 1:20200 OUTER DR
Mailing Address - Street 2:
Mailing Address - City:DEARBORN
Mailing Address - State:MI
Mailing Address - Zip Code:48124-2634
Mailing Address - Country:US
Mailing Address - Phone:313-624-8417
Mailing Address - Fax:313-357-7074
Practice Address - Street 1:20200 OUTER DR
Practice Address - Street 2:
Practice Address - City:DEARBORN
Practice Address - State:MI
Practice Address - Zip Code:48124-2634
Practice Address - Country:US
Practice Address - Phone:313-624-8417
Practice Address - Fax:313-357-7074
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-03-03
Last Update Date:2021-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MISS051535207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1811956139Medicaid
MI=========OtherTAX ID