Provider Demographics
NPI:1922468438
Name:SALEM, NADA
Entity Type:Individual
Prefix:
First Name:NADA
Middle Name:
Last Name:SALEM
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6115 WHITEFIELD ST
Mailing Address - Street 2:
Mailing Address - City:DEARBORN HEIGHTS
Mailing Address - State:MI
Mailing Address - Zip Code:48127-3012
Mailing Address - Country:US
Mailing Address - Phone:216-704-6579
Mailing Address - Fax:
Practice Address - Street 1:6221 N TELEGRAPH RD
Practice Address - Street 2:
Practice Address - City:DEARBORN HEIGHTS
Practice Address - State:MI
Practice Address - Zip Code:48127-3222
Practice Address - Country:US
Practice Address - Phone:313-561-2200
Practice Address - Fax:313-561-2211
Is Sole Proprietor?:Yes
Enumeration Date:2016-02-25
Last Update Date:2021-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH50.004627RX363A00000X
MI5601009163363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant