Provider Demographics
NPI:1104558287
Name:SUSSAN J SALAS MD PLLC
Entity type:Organization
Organization Name:SUSSAN J SALAS MD PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SUSSAN
Authorized Official - Middle Name:
Authorized Official - Last Name:SALAS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:734-855-4358
Mailing Address - Street 1:14555 LEVAN RD STE 312
Mailing Address - Street 2:
Mailing Address - City:LIVONIA
Mailing Address - State:MI
Mailing Address - Zip Code:48154-5085
Mailing Address - Country:US
Mailing Address - Phone:734-855-4358
Mailing Address - Fax:
Practice Address - Street 1:14555 LEVAN RD STE 312
Practice Address - Street 2:
Practice Address - City:LIVONIA
Practice Address - State:MI
Practice Address - Zip Code:48154-5085
Practice Address - Country:US
Practice Address - Phone:734-855-4358
Practice Address - Fax:734-744-4505
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-06-28
Last Update Date:2022-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
No207T00000XAllopathic & Osteopathic PhysiciansNeurological SurgeryGroup - Single Specialty