Provider Demographics
NPI:1366613713
Name:DHAFER S. SALAMA M.D. P.C.
Entity type:Organization
Organization Name:DHAFER S. SALAMA M.D. P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DHAFER
Authorized Official - Middle Name:S
Authorized Official - Last Name:SALAMA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:586-574-0222
Mailing Address - Street 1:11446 E 13 MILE RD
Mailing Address - Street 2:SUITE A
Mailing Address - City:WARREN
Mailing Address - State:MI
Mailing Address - Zip Code:48093-6571
Mailing Address - Country:US
Mailing Address - Phone:586-574-0222
Mailing Address - Fax:
Practice Address - Street 1:11446 E 13 MILE RD
Practice Address - Street 2:SUITE A
Practice Address - City:WARREN
Practice Address - State:MI
Practice Address - Zip Code:48093-6571
Practice Address - Country:US
Practice Address - Phone:586-574-0222
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-13
Last Update Date:2008-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIDS043124207YX0905X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207YX0905XAllopathic & Osteopathic PhysiciansOtolaryngologyOtolaryngology/Facial Plastic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MID83157Medicare UPIN
MI0500392Medicare PIN