Provider Demographics
NPI:1023014610
Name:GHALI, MOHAMMAD (MD)
Entity Type:Individual
Prefix:DR
First Name:MOHAMMAD
Middle Name:
Last Name:GHALI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:505 N JACKSON ST
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:MI
Mailing Address - Zip Code:49201-1266
Mailing Address - Country:US
Mailing Address - Phone:517-748-5500
Mailing Address - Fax:517-780-9286
Practice Address - Street 1:5700 MONROE STREET
Practice Address - Street 2:WUITE 301
Practice Address - City:SYLVANIA
Practice Address - State:OH
Practice Address - Zip Code:43560-2737
Practice Address - Country:US
Practice Address - Phone:419-291-2121
Practice Address - Fax:419-479-6017
Is Sole Proprietor?:No
Enumeration Date:2005-06-28
Last Update Date:2023-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301057489208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI3479730-10Medicaid
MIM12180001Medicare ID - Type UnspecifiedMEDICARE PART B #
MI3479730-10Medicaid