Doctor Name: | LAUREN SALL |
NPI Number: | 1457733131 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | M.D. |
License Number: | 5315069754 |
Business Practice Address: | 19251 Mack Ave Suite 340 Grosse Pointe Woods, MI - 482362893 |
Business Phone Number: | 3133433878 |
Business Fax Number: | |
Mailing Address: | 22101 Moross Rd, Ste 212 DETROIT |
State: | MI |
Postal Code: | 482362148 |
Phone Number: | 3133437849 |
Fax Number: | |
NPI Enumeration Date: | 06/18/2015 |
NPI Last Update Date: | 06/13/2016 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 390200000X |
License Number: | 5315069754 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | MI |
Taxonomy Type: | Student, Health Care |
Taxonomy Classification: | Student in an Organized Health Care Education/Training Program |
Taxonomy Specialization: | |
Taxonomy Definition: | An individual who is enrolled in an organized health care education/training program leading to a degree, certification, registration, and/or licensure to provide health care. |