Provider Demographics
NPI:1336301084
Name:ZEINEDDINE, SALAM (MD)
Entity Type:Individual
Prefix:DR
First Name:SALAM
Middle Name:
Last Name:ZEINEDDINE
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 1:1560 E MAPLE RD
Mailing Address - Street 2:SUITE 400-CREDENTIALING DEPARTMENT
Mailing Address - City:TROY
Mailing Address - State:MI
Mailing Address - Zip Code:48083-1138
Mailing Address - Country:US
Mailing Address - Phone:313-745-4525
Mailing Address - Fax:313-966-7305
Practice Address - Street 1:50 E CANFIELD ST
Practice Address - Street 2:GENERAL MEDICINE AMBULATORY PRACTICE
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48201-1804
Practice Address - Country:US
Practice Address - Phone:313-745-4525
Practice Address - Fax:313-966-7305
Is Sole Proprietor?:No
Enumeration Date:2008-06-25
Last Update Date:2015-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301106936207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX286347401Medicaid
TXTXB141405Medicare PIN