Provider Demographics
NPI:1386643013
Name:MAHMOOD, ALI H (MD)
Entity Type:Individual
Prefix:DR
First Name:ALI
Middle Name:H
Last Name:MAHMOOD
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:PO BOX 33722
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48232-3722
Mailing Address - Country:US
Mailing Address - Phone:313-893-5490
Mailing Address - Fax:313-893-5495
Practice Address - Street 1:13031 CONANT ST
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48212-2361
Practice Address - Country:US
Practice Address - Phone:313-893-5490
Practice Address - Fax:313-893-5495
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-15
Last Update Date:2020-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIAM056507207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4283129Medicaid
MI1108212991OtherBCBS PIN
MI4653542Medicaid
MI0P03100001Medicare PIN
MI4283129Medicaid
MIG07647Medicare UPIN