Provider Demographics
NPI:1669834040
Name:AMERICAN PHSYCHIATRIC & NEUROSCIENCE INSTITUTE PC
Entity Type:Organization
Organization Name:AMERICAN PHSYCHIATRIC & NEUROSCIENCE INSTITUTE PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:WISAM
Authorized Official - Middle Name:A
Authorized Official - Last Name:SALMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:313-945-8110
Mailing Address - Street 1:30 BRADFORD CT
Mailing Address - Street 2:
Mailing Address - City:DEARBORN
Mailing Address - State:MI
Mailing Address - Zip Code:48126-4169
Mailing Address - Country:US
Mailing Address - Phone:313-599-7762
Mailing Address - Fax:
Practice Address - Street 1:30 BRADFORD CT
Practice Address - Street 2:
Practice Address - City:DEARBORN
Practice Address - State:MI
Practice Address - Zip Code:48126-4169
Practice Address - Country:US
Practice Address - Phone:313-599-7762
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-03-24
Last Update Date:2016-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIPENDINGMedicare PIN