Provider Demographics
NPI:1114032414
Name:MAKKI, ALI S (MD)
Entity Type:Individual
Prefix:DR
First Name:ALI
Middle Name:S
Last Name:MAKKI
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 1:22239 WEST WARREN AVE.
Mailing Address - Street 2:
Mailing Address - City:DEARBORN HEIGHTS
Mailing Address - State:MI
Mailing Address - Zip Code:48127
Mailing Address - Country:US
Mailing Address - Phone:313-908-4255
Mailing Address - Fax:313-908-4642
Practice Address - Street 1:22239 WEST WARREN AVE.
Practice Address - Street 2:
Practice Address - City:DEARBORN HEIGHTS
Practice Address - State:MI
Practice Address - Zip Code:48127
Practice Address - Country:US
Practice Address - Phone:313-908-4255
Practice Address - Fax:313-908-4642
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-20
Last Update Date:2014-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301048780207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1114032Medicaid
MI1114032Medicaid
MIA76154Medicare UPIN