Provider Demographics
NPI:1689130056
Name:CITY CLINIC LLC
Entity Type:Organization
Organization Name:CITY CLINIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TARICK
Authorized Official - Middle Name:
Authorized Official - Last Name:SALAMEY
Authorized Official - Suffix:
Authorized Official - Credentials:FNP
Authorized Official - Phone:313-732-0100
Mailing Address - Street 1:15615 W MCNICHOLS RD
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48235-3541
Mailing Address - Country:US
Mailing Address - Phone:313-732-0100
Mailing Address - Fax:
Practice Address - Street 1:15615 W MCNICHOLS RD
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48235-3541
Practice Address - Country:US
Practice Address - Phone:313-732-0100
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-02-11
Last Update Date:2019-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty