Provider Demographics
NPI:1124012752
Name:MSALLATY, ZAHER (MD)
Entity Type:Individual
Prefix:
First Name:ZAHER
Middle Name:
Last Name:MSALLATY
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 1:22255 GREENFIELD RD STE 400
Mailing Address - Street 2:
Mailing Address - City:SOUTHFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48075-3734
Mailing Address - Country:US
Mailing Address - Phone:248-849-4880
Mailing Address - Fax:248-849-4881
Practice Address - Street 1:22255 GREENFIELD RD STE 400
Practice Address - Street 2:
Practice Address - City:SOUTHFIELD
Practice Address - State:MI
Practice Address - Zip Code:48075-3734
Practice Address - Country:US
Practice Address - Phone:248-849-4880
Practice Address - Fax:248-849-4881
Is Sole Proprietor?:No
Enumeration Date:2005-09-09
Last Update Date:2021-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK30181207RE0101X
MI4301089761207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY64079130Medicaid
I03959Medicare UPIN
KY0396126Medicare ID - Type Unspecified