Provider Demographics
NPI:1205839909
Name:SALEM, GARY SHELDON (DO)
Entity Type:Individual
Prefix:
First Name:GARY
Middle Name:SHELDON
Last Name:SALEM
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 585
Mailing Address - Street 2:
Mailing Address - City:OXFORD
Mailing Address - State:MI
Mailing Address - Zip Code:48371-0585
Mailing Address - Country:US
Mailing Address - Phone:810-219-8550
Mailing Address - Fax:
Practice Address - Street 1:13137 N CLIO RD
Practice Address - Street 2:
Practice Address - City:CLIO
Practice Address - State:MI
Practice Address - Zip Code:48420-1028
Practice Address - Country:US
Practice Address - Phone:313-590-9170
Practice Address - Fax:844-274-3091
Is Sole Proprietor?:No
Enumeration Date:2005-05-27
Last Update Date:2022-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5101008983208M00000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0D40045OtherBCBSM
MI4846709Medicaid
MI1205839909OtherNPI
MI0D40045OtherBCBSM
MI4846709Medicaid