Provider Demographics
NPI:1497741300
Name:SALESIN, MICHAEL S (MD)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:S
Last Name:SALESIN
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 1:2300 HAGGERTY RD
Mailing Address - Street 2:STE 2070
Mailing Address - City:WEST BLOOMFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48323-2184
Mailing Address - Country:US
Mailing Address - Phone:248-926-2020
Mailing Address - Fax:248-926-9020
Practice Address - Street 1:2300 HAGGERTY RD
Practice Address - Street 2:STE 2070
Practice Address - City:WEST BLOOMFIELD
Practice Address - State:MI
Practice Address - Zip Code:48323-2184
Practice Address - Country:US
Practice Address - Phone:248-926-2020
Practice Address - Fax:248-926-9020
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-26
Last Update Date:2010-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIMS027057207VG0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4495953Medicaid
MI0906303851OtherBLUE CROSS GROUP PIN
MI1497741300OtherNPI
MI1497741300OtherNPI
MI4495953Medicaid