Provider Demographics
NPI:1093979593
Name:SALEM, FARAH KIRMA (MD)
Entity Type:Individual
Prefix:
First Name:FARAH
Middle Name:KIRMA
Last Name:SALEM
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:28111 HOOVER RD STE 5A
Mailing Address - Street 2:
Mailing Address - City:WARREN
Mailing Address - State:MI
Mailing Address - Zip Code:48093-4153
Mailing Address - Country:US
Mailing Address - Phone:586-578-9606
Mailing Address - Fax:586-578-9806
Practice Address - Street 1:28111 HOOVER RD STE 5A
Practice Address - Street 2:
Practice Address - City:WARREN
Practice Address - State:MI
Practice Address - Zip Code:48093-4153
Practice Address - Country:US
Practice Address - Phone:586-578-9606
Practice Address - Fax:586-578-9806
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-14
Last Update Date:2023-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301085710207R00000X
CAA104618208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIN40170229Medicare PIN