Provider Demographics
NPI:1871326827
Name:DARKAZANLI, SALAM (CDR)
Entity type:Individual
Prefix:
First Name:SALAM
Middle Name:
Last Name:DARKAZANLI
Suffix:
Gender:F
Credentials:CDR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4138 TIMBER RIDGE DR
Mailing Address - Street 2:
Mailing Address - City:ANN ARBOR
Mailing Address - State:MI
Mailing Address - Zip Code:48108-2796
Mailing Address - Country:US
Mailing Address - Phone:703-732-8636
Mailing Address - Fax:
Practice Address - Street 1:4138 TIMBER RIDGE DR
Practice Address - Street 2:
Practice Address - City:ANN ARBOR
Practice Address - State:MI
Practice Address - Zip Code:48108-2796
Practice Address - Country:US
Practice Address - Phone:703-732-8636
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-08-24
Last Update Date:2024-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI86290306133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered