Provider Demographics
NPI:1205838307
Name:DAIMEE, MUDASSIR ALI (MD)
Entity Type:Individual
Prefix:DR
First Name:MUDASSIR
Middle Name:ALI
Last Name:DAIMEE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4967 CROOKS RD
Mailing Address - Street 2:STE 130
Mailing Address - City:TROY
Mailing Address - State:MI
Mailing Address - Zip Code:48098-5801
Mailing Address - Country:US
Mailing Address - Phone:248-952-1601
Mailing Address - Fax:248-952-0192
Practice Address - Street 1:4967 CROOKS RD
Practice Address - Street 2:STE 130
Practice Address - City:TROY
Practice Address - State:MI
Practice Address - Zip Code:48098-5801
Practice Address - Country:US
Practice Address - Phone:248-952-1601
Practice Address - Fax:248-952-0192
Is Sole Proprietor?:No
Enumeration Date:2005-06-02
Last Update Date:2007-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301076708207R00000X, 208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4846342Medicaid
MI70-0-F32947-0OtherBCBS CPIN #
MIMD076708OtherBCBSM
MI1205838307OtherNPI #
MI70-0-F32947-0OtherBCBS CPIN #
H82869Medicare UPIN