Provider Demographics
NPI:1336785005
Name:SALTA OF CLARKSTON, PLLC
Entity Type:Organization
Organization Name:SALTA OF CLARKSTON, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:A
Authorized Official - Last Name:BLANCHARD
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:248-206-1200
Mailing Address - Street 1:1627 W BIG BEAVER RD
Mailing Address - Street 2:
Mailing Address - City:TROY
Mailing Address - State:MI
Mailing Address - Zip Code:48084-3501
Mailing Address - Country:US
Mailing Address - Phone:248-220-1560
Mailing Address - Fax:248-220-1563
Practice Address - Street 1:6483 CITATION DR STE B
Practice Address - Street 2:
Practice Address - City:CLARKSTON
Practice Address - State:MI
Practice Address - Zip Code:48346-2994
Practice Address - Country:US
Practice Address - Phone:248-861-0010
Practice Address - Fax:248-861-0020
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-11-18
Last Update Date:2022-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty