Provider Demographics
NPI:1902329600
Name:TRISTAR HEALTH PC
Entity Type:Organization
Organization Name:TRISTAR HEALTH PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:RESIDENT AGENT
Authorized Official - Prefix:MR
Authorized Official - First Name:SALAHUDDIN
Authorized Official - Middle Name:S
Authorized Official - Last Name:AHMAD
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:248-761-4565
Mailing Address - Street 1:808 LIVERNOIS ST
Mailing Address - Street 2:
Mailing Address - City:FERNDALE
Mailing Address - State:MI
Mailing Address - Zip Code:48220-2309
Mailing Address - Country:US
Mailing Address - Phone:248-761-4565
Mailing Address - Fax:248-336-9230
Practice Address - Street 1:808 LIVERNOIS RD
Practice Address - Street 2:
Practice Address - City:FERNDALE
Practice Address - State:MI
Practice Address - Zip Code:48220-2309
Practice Address - Country:US
Practice Address - Phone:248-761-4565
Practice Address - Fax:248-336-9230
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-07-25
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty