Provider Demographics
NPI:1932173705
Name:SALEM, NANDA G (MD)
Entity Type:Individual
Prefix:DR
First Name:NANDA
Middle Name:G
Last Name:SALEM
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10861 W 10 MILE RD
Mailing Address - Street 2:
Mailing Address - City:OAK PARK
Mailing Address - State:MI
Mailing Address - Zip Code:48237-1745
Mailing Address - Country:US
Mailing Address - Phone:248-268-1135
Mailing Address - Fax:248-268-1191
Practice Address - Street 1:10861 W 10 MILE RD
Practice Address - Street 2:
Practice Address - City:OAK PARK
Practice Address - State:MI
Practice Address - Zip Code:48237-1745
Practice Address - Country:US
Practice Address - Phone:248-268-1135
Practice Address - Fax:248-268-1191
Is Sole Proprietor?:No
Enumeration Date:2006-02-16
Last Update Date:2014-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301034670207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
B48525Medicare UPIN
MIM54550005Medicare ID - Type Unspecified
MI1393109Medicaid