Basic Information
| Provider Information | |||||||||
| NPI: | 1912229451 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | ELDOHIRI | ||||||||
| FirstName: | SALAH ELDIN | ||||||||
| MiddleName: | ELSAID | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4800 S SAGINAW ST STE 1815 | ||||||||
| Address2: | |||||||||
| City: | FLINT | ||||||||
| State: | MI | ||||||||
| PostalCode: | 485072677 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8102759152 | ||||||||
| FaxNumber: | 8102130228 | ||||||||
| Practice Location | |||||||||
| Address1: | 4800 S SAGINAW ST STE 1815 | ||||||||
| Address2: | |||||||||
| City: | FLINT | ||||||||
| State: | MI | ||||||||
| PostalCode: | 485072677 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8102759152 | ||||||||
| FaxNumber: | 8102130228 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/25/2010 | ||||||||
| LastUpdateDate: | 01/20/2016 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207LP2900X | 4301091833 | MI | Y | Allopathic & Osteopathic Physicians | Anesthesiology | Pain Medicine |
ID Information
| ID | Type | State | Issuer | Description | 4301091833 | 01 | MI | MICHIGAN MEDICAL NUMBER | OTHER | FE4737310 | 01 | MI | DEA NUMBER | OTHER | 1912229451 | 05 | MI | MEDICAID |