Provider Demographics
NPI:1194796185
Name:ALENZI, SALAH ABBAS (MD)
Entity type:Individual
Prefix:DR
First Name:SALAH
Middle Name:ABBAS
Last Name:ALENZI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:19401 HUBBARD DR
Mailing Address - Street 2:
Mailing Address - City:DEARBORN
Mailing Address - State:MI
Mailing Address - Zip Code:48126-2641
Mailing Address - Country:US
Mailing Address - Phone:313-982-4400
Mailing Address - Fax:313-982-8234
Practice Address - Street 1:19401 HUBBARD DR
Practice Address - Street 2:
Practice Address - City:DEARBORN
Practice Address - State:MI
Practice Address - Zip Code:48126-2641
Practice Address - Country:US
Practice Address - Phone:313-982-4400
Practice Address - Fax:313-982-8234
Is Sole Proprietor?:No
Enumeration Date:2006-01-30
Last Update Date:2024-02-29
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI4301069303207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0108284841OtherBCBSM
MI4165018Medicaid
MI0108284841OtherBCBSM
MIH11686Medicare UPIN