Provider Demographics
NPI:1053675462
Name:ALALI, SAMHAR M (MD)
Entity Type:Individual
Prefix:
First Name:SAMHAR
Middle Name:M
Last Name:ALALI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:MOHAMMED SAMHAR
Other - Middle Name:
Other - Last Name:ALKHALAF ALALI
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:1000 HOUGHTON AVE
Mailing Address - Street 2:
Mailing Address - City:SAGINAW
Mailing Address - State:MI
Mailing Address - Zip Code:48602-5303
Mailing Address - Country:US
Mailing Address - Phone:989-583-6800
Mailing Address - Fax:989-583-6955
Practice Address - Street 1:1000 HOUGHTON AVE
Practice Address - Street 2:
Practice Address - City:SAGINAW
Practice Address - State:MI
Practice Address - Zip Code:48602-5303
Practice Address - Country:US
Practice Address - Phone:989-583-6800
Practice Address - Fax:989-583-6955
Is Sole Proprietor?:No
Enumeration Date:2012-06-29
Last Update Date:2016-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
MI4301108321208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1053675462Medicaid