Provider Demographics
NPI:1962879759
Name:ALSALIK, ZINA
Entity type:Individual
Prefix:MRS
First Name:ZINA
Middle Name:
Last Name:ALSALIK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18050 OUTER DR
Mailing Address - Street 2:
Mailing Address - City:DEARBORN
Mailing Address - State:MI
Mailing Address - Zip Code:48128-1335
Mailing Address - Country:US
Mailing Address - Phone:313-623-2992
Mailing Address - Fax:
Practice Address - Street 1:19230 FORD RD
Practice Address - Street 2:APT 710
Practice Address - City:DEARBORN
Practice Address - State:MI
Practice Address - Zip Code:48128-2000
Practice Address - Country:US
Practice Address - Phone:313-623-2992
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-08-27
Last Update Date:2015-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIA424982014731320700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320700000XResidential Treatment FacilitiesResidential Treatment Facility, Physical Disabilities