Provider Demographics
NPI:1528009487
Name:SALIB, MARCELLA R (MD)
Entity Type:Individual
Prefix:DR
First Name:MARCELLA
Middle Name:R
Last Name:SALIB
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:MARCELLE
Other - Middle Name:RIDA
Other - Last Name:SALIB
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:37008 CURTIS RD
Mailing Address - Street 2:
Mailing Address - City:LIVONIA
Mailing Address - State:MI
Mailing Address - Zip Code:48152-4089
Mailing Address - Country:US
Mailing Address - Phone:734-542-0817
Mailing Address - Fax:734-542-0819
Practice Address - Street 1:37008 CURTIS RD
Practice Address - Street 2:
Practice Address - City:LIVONIA
Practice Address - State:MI
Practice Address - Zip Code:48152-4089
Practice Address - Country:US
Practice Address - Phone:734-542-0817
Practice Address - Fax:734-542-0819
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-09
Last Update Date:2015-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI42066207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI002346OtherDMC PROVIDER #
MI1679287Medicaid
MI0829624OtherBCBS PROVIDER #
MI4066566OtherAETNA PROVIDER #
MIB44294Medicare UPIN
MI1679287Medicaid