Provider Demographics
NPI:1780658625
Name:DUA, SALIL (MD)
Entity Type:Individual
Prefix:DR
First Name:SALIL
Middle Name:
Last Name:DUA
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 1:2121 E GRAND RIVER AVE
Mailing Address - Street 2:
Mailing Address - City:LANSING
Mailing Address - State:MI
Mailing Address - Zip Code:48912-3231
Mailing Address - Country:US
Mailing Address - Phone:248-845-8507
Mailing Address - Fax:248-243-8719
Practice Address - Street 1:2121 E GRAND RIVER AVE
Practice Address - Street 2:
Practice Address - City:LANSING
Practice Address - State:MI
Practice Address - Zip Code:48912-3231
Practice Address - Country:US
Practice Address - Phone:248-845-8507
Practice Address - Fax:248-243-8719
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-16
Last Update Date:2022-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301072671207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4421646Medicaid
MI4354650Medicaid
MI0N52470Medicare ID - Type Unspecified
MI4354650Medicaid