Provider Demographics
NPI:1457337529
Name:SALEM, NANCY A (MD)
Entity Type:Individual
Prefix:DR
First Name:NANCY
Middle Name:A
Last Name:SALEM
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:NANCY
Other - Middle Name:AHMED
Other - Last Name:SALEM
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:6079 W MAPLE RD
Mailing Address - Street 2:SUITE 110
Mailing Address - City:WEST BLOOMFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48322-2283
Mailing Address - Country:US
Mailing Address - Phone:248-325-9615
Mailing Address - Fax:248-325-9613
Practice Address - Street 1:6079 W MAPLE RD
Practice Address - Street 2:SUITE 110
Practice Address - City:WEST BLOOMFIELD
Practice Address - State:MI
Practice Address - Zip Code:48322-2283
Practice Address - Country:US
Practice Address - Phone:248-325-9615
Practice Address - Fax:248-325-9613
Is Sole Proprietor?:No
Enumeration Date:2005-12-20
Last Update Date:2011-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301074072207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4573559Medicaid
5315008550OtherCONTROLLED SUBSTANCE
MIP50820007Medicare PIN
5315008550OtherCONTROLLED SUBSTANCE
N71840025Medicare ID - Type Unspecified