Provider Demographics
NPI:1215161799
Name:SALMELA, GARY M
Entity type:Individual
Prefix:
First Name:GARY
Middle Name:M
Last Name:SALMELA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:26 SOUTH
Mailing Address - Street 2:PO BOX 392
Mailing Address - City:SOUDAN
Mailing Address - State:MN
Mailing Address - Zip Code:55782-0392
Mailing Address - Country:US
Mailing Address - Phone:218-753-6310
Mailing Address - Fax:
Practice Address - Street 1:26 SOUTH
Practice Address - Street 2:
Practice Address - City:SOUDAN
Practice Address - State:MN
Practice Address - Zip Code:55782-0392
Practice Address - Country:US
Practice Address - Phone:218-753-6310
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-05-12
Last Update Date:2009-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN59682-001304996-00OtherMEDICA
MN59682-000373092-00OtherMEDICA