Provider Demographics
NPI:1700970506
Name:SALEM, MANAL HIKMAT (MD)
Entity Type:Individual
Prefix:DR
First Name:MANAL
Middle Name:HIKMAT
Last Name:SALEM
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:31700 VAN DYKE AVE
Mailing Address - Street 2:
Mailing Address - City:WARREN
Mailing Address - State:MI
Mailing Address - Zip Code:48093-7949
Mailing Address - Country:US
Mailing Address - Phone:586-276-8200
Mailing Address - Fax:586-276-8181
Practice Address - Street 1:315 S WAYNE RD
Practice Address - Street 2:
Practice Address - City:WESTLAND
Practice Address - State:MI
Practice Address - Zip Code:48186-4301
Practice Address - Country:US
Practice Address - Phone:734-895-8396
Practice Address - Fax:734-895-8571
Is Sole Proprietor?:No
Enumeration Date:2006-10-03
Last Update Date:2019-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301074853207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4936010Medicaid
MII19574Medicare UPIN