Provider Demographics
NPI:1144412149
Name:DANIEL SALAMA DPM PC
Entity Type:Organization
Organization Name:DANIEL SALAMA DPM PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:
Authorized Official - Last Name:SALAMA
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:248-474-0040
Mailing Address - Street 1:2200 MONROE ST STE 1
Mailing Address - Street 2:
Mailing Address - City:DEARBORN
Mailing Address - State:MI
Mailing Address - Zip Code:48124-3058
Mailing Address - Country:US
Mailing Address - Phone:313-274-0990
Mailing Address - Fax:313-274-8120
Practice Address - Street 1:2200 MONROE ST STE 1
Practice Address - Street 2:
Practice Address - City:DEARBORN
Practice Address - State:MI
Practice Address - Zip Code:48124-3058
Practice Address - Country:US
Practice Address - Phone:313-274-0990
Practice Address - Fax:313-274-8120
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-14
Last Update Date:2022-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIDS001380213E00000X
213E00000X, 213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
No213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIC00882OtherMEDICARE RAILROAD
MI4856353910OtherBCBSM PIN
MI3045060Medicaid
MI5635391Medicare PIN
MIC00882OtherMEDICARE RAILROAD
MIT34201Medicare UPIN
MI0P58920Medicare PIN