Provider Demographics
NPI:1053688952
Name:DABAJA, ALI H (DO)
Entity Type:Individual
Prefix:
First Name:ALI
Middle Name:H
Last Name:DABAJA
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:DEPT 259301
Mailing Address - Street 2:P O BOX 67000
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48267-2593
Mailing Address - Country:US
Mailing Address - Phone:734-266-2780
Mailing Address - Fax:734-466-9615
Practice Address - Street 1:116 S DENWOOD ST
Practice Address - Street 2:
Practice Address - City:DEARBORN
Practice Address - State:MI
Practice Address - Zip Code:48124-1310
Practice Address - Country:US
Practice Address - Phone:734-266-2780
Practice Address - Fax:734-466-9615
Is Sole Proprietor?:No
Enumeration Date:2011-11-20
Last Update Date:2020-01-24
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI5101020852207P00000X, 207RC0200X
WI66361207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1053688952Medicaid
MI1053688952Medicaid
MI1053688952Medicaid