Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213E00000X | Podiatrist | DS001380 | MI |
Y | 222Z00000X | Podiatrist | DS001380 | MI |
NPI | 1003861964 |
---|---|
Provider Name | Daniel Salama |
First Address | Farmington Hills, MI 48336 |
Second Address | Farmington Hills, MI 48336 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/05/2006 |
Last Update Date | 20/08/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
3045060 | (05) | MI |
4856353910 | BCBSM PIN (01) | MI |
T34201 | (02) |