Provider Demographics
NPI:1326495664
Name:ALI, SHUJAT
Entity Type:Individual
Prefix:
First Name:SHUJAT
Middle Name:
Last Name:ALI
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10645 W WARREN AVE
Mailing Address - Street 2:SUIT 300
Mailing Address - City:DEARBORN
Mailing Address - State:MI
Mailing Address - Zip Code:48126-8009
Mailing Address - Country:US
Mailing Address - Phone:313-846-0555
Mailing Address - Fax:313-846-0565
Practice Address - Street 1:10645 W WARREN AVE
Practice Address - Street 2:SUIT 300
Practice Address - City:DEARBORN
Practice Address - State:MI
Practice Address - Zip Code:48126-8009
Practice Address - Country:US
Practice Address - Phone:313-846-0555
Practice Address - Fax:313-846-0565
Is Sole Proprietor?:No
Enumeration Date:2016-05-17
Last Update Date:2016-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501017540225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist