Provider Demographics
NPI:1780118497
Name:SALEM MEDICAL P.C.
Entity type:Organization
Organization Name:SALEM MEDICAL P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:FARAH
Authorized Official - Middle Name:K
Authorized Official - Last Name:SALEM
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:586-578-9606
Mailing Address - Street 1:28111 HOOVER RD STE 5A
Mailing Address - Street 2:
Mailing Address - City:WARREN
Mailing Address - State:MI
Mailing Address - Zip Code:48093-4153
Mailing Address - Country:US
Mailing Address - Phone:586-578-9606
Mailing Address - Fax:586-578-9806
Practice Address - Street 1:28111 HOOVER RD
Practice Address - Street 2:STE 5
Practice Address - City:WARREN
Practice Address - State:MI
Practice Address - Zip Code:48093-4153
Practice Address - Country:US
Practice Address - Phone:586-854-0098
Practice Address - Fax:248-220-4269
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-04-19
Last Update Date:2023-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301085710207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty