Provider Demographics
NPI:1033370473
Name:ABU ALI, QAIS (MD)
Entity Type:Individual
Prefix:
First Name:QAIS
Middle Name:
Last Name:ABU ALI
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 1:4506 STEPHENS CIR NW
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:OH
Mailing Address - Zip Code:44718-3628
Mailing Address - Country:US
Mailing Address - Phone:330-994-0436
Mailing Address - Fax:330-492-4906
Practice Address - Street 1:4506 STEPHENS CIR NW
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:OH
Practice Address - Zip Code:44718-3628
Practice Address - Country:US
Practice Address - Phone:330-994-0436
Practice Address - Fax:330-492-4906
Is Sole Proprietor?:No
Enumeration Date:2008-06-18
Last Update Date:2012-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301079654390200000X
AZ40491170100000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
No170100000XOther Service ProvidersMedical Genetics, Ph.D. Medical Genetics