Provider Demographics
NPI:1700576832
Name:SALEH, MUNTHER
Entity Type:Individual
Prefix:
First Name:MUNTHER
Middle Name:
Last Name:SALEH
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2843 AMAZON ST
Mailing Address - Street 2:
Mailing Address - City:DEARBORN
Mailing Address - State:MI
Mailing Address - Zip Code:48120-1526
Mailing Address - Country:US
Mailing Address - Phone:313-695-1288
Mailing Address - Fax:
Practice Address - Street 1:13111 WOODWARD AVE
Practice Address - Street 2:
Practice Address - City:HIGHLAND PARK
Practice Address - State:MI
Practice Address - Zip Code:48203-3781
Practice Address - Country:US
Practice Address - Phone:313-865-9900
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-11
Last Update Date:2024-03-26
Deactivation Date:2023-08-06
Deactivation Code:
Reactivation Date:2024-03-26
Provider Licenses
StateLicense IDTaxonomies
343900000X
MI5302413375183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
No343900000XTransportation ServicesNon-emergency Medical Transport (VAN)