Provider Demographics
NPI:1558574137
Name:FATEH, SALMAN A (DO)
Entity Type:Individual
Prefix:
First Name:SALMAN
Middle Name:A
Last Name:FATEH
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1080 HARRINGTON ST
Mailing Address - Street 2:SUITE 202
Mailing Address - City:MOUNT CLEMENS
Mailing Address - State:MI
Mailing Address - Zip Code:48043-2901
Mailing Address - Country:US
Mailing Address - Phone:586-493-3440
Mailing Address - Fax:586-493-3445
Practice Address - Street 1:1080 HARRINGTON ST
Practice Address - Street 2:SUITE 202
Practice Address - City:MOUNT CLEMENS
Practice Address - State:MI
Practice Address - Zip Code:48043-2901
Practice Address - Country:US
Practice Address - Phone:586-493-3440
Practice Address - Fax:586-493-3445
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-08
Last Update Date:2016-02-18
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI5101017226207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI5315043762OtherCONTROLLED DRUG LICENSE
MI5101017226OtherSTATE LICENSE ID
MI5630982OtherBCBSM
MI5630982OtherBCBSM
MI5315043762OtherCONTROLLED DRUG LICENSE