Basic Information
| Provider Information | |||||||||
| NPI: | 1336301084 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | ZEINEDDINE | ||||||||
| FirstName: | SALAM | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | M.D | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1560 E MAPLE RD | ||||||||
| Address2: | SUITE 400-CREDENTIALING DEPARTMENT | ||||||||
| City: | TROY | ||||||||
| State: | MI | ||||||||
| PostalCode: | 480831138 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3137454525 | ||||||||
| FaxNumber: | 3139667305 | ||||||||
| Practice Location | |||||||||
| Address1: | 50 E CANFIELD ST | ||||||||
| Address2: | GENERAL MEDICINE AMBULATORY PRACTICE | ||||||||
| City: | DETROIT | ||||||||
| State: | MI | ||||||||
| PostalCode: | 482011804 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3137454525 | ||||||||
| FaxNumber: | 3139667305 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/25/2008 | ||||||||
| LastUpdateDate: | 06/08/2015 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 4301106936 | MI | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
ID Information
| ID | Type | State | Issuer | Description | 286347401 | 05 | TX | MEDICAID |