Provider Demographics
NPI:1144257148
Name:OWOSSO MEDICAL ASSOCIATES PC
Entity type:Organization
Organization Name:OWOSSO MEDICAL ASSOCIATES PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:WAEL
Authorized Official - Middle Name:J
Authorized Official - Last Name:SALMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:989-729-4222
Mailing Address - Street 1:300 HEALTH PARK DR
Mailing Address - Street 2:STE 304
Mailing Address - City:OWOSSO
Mailing Address - State:MI
Mailing Address - Zip Code:48867-1293
Mailing Address - Country:US
Mailing Address - Phone:989-729-4222
Mailing Address - Fax:989-729-4968
Practice Address - Street 1:300 HEALTH PARK DR.
Practice Address - Street 2:SUITE 304
Practice Address - City:OWOSSO
Practice Address - State:MI
Practice Address - Zip Code:48867
Practice Address - Country:US
Practice Address - Phone:989-729-4222
Practice Address - Fax:989-729-4968
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-26
Last Update Date:2011-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301059658207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4467752Medicaid
MIG18018Medicare UPIN
MI4467752Medicaid