Provider Demographics
NPI:1063640068
Name:ALI, ABUBAKER AHMED (MD)
Entity Type:Individual
Prefix:DR
First Name:ABUBAKER
Middle Name:AHMED
Last Name: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 1:13051 OSBORNE ST
Mailing Address - Street 2:APT 608
Mailing Address - City:DEARBORN
Mailing Address - State:MI
Mailing Address - Zip Code:48126-4037
Mailing Address - Country:US
Mailing Address - Phone:313-878-7575
Mailing Address - Fax:
Practice Address - Street 1:13051 OSBORNE ST
Practice Address - Street 2:APT 608
Practice Address - City:DEARBORN
Practice Address - State:MI
Practice Address - Zip Code:48126-4037
Practice Address - Country:US
Practice Address - Phone:313-878-7575
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-29
Last Update Date:2009-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301094760208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery