Provider Demographics
NPI:1407939432
Name:SALAMA, MAYER (DPM)
Entity Type:Individual
Prefix:DR
First Name:MAYER
Middle Name:
Last Name:SALAMA
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2200 MONROE ST
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 1:18600 VAN HORN RD
Practice Address - Street 2:
Practice Address - City:WOODHAVEN
Practice Address - State:MI
Practice Address - Zip Code:48183-3828
Practice Address - Country:US
Practice Address - Phone:734-675-2440
Practice Address - Fax:734-675-6738
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-23
Last Update Date:2009-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIMS000918213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1799427Medicaid
MIT34339Medicare UPIN
MI5825119Medicare PIN