Provider Demographics
NPI:1386839215
Name:ALI NASSER MD PC
Entity Type:Organization
Organization Name:ALI NASSER MD PC
Other - Org Name:SAME
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ALI
Authorized Official - Middle Name:MOHAMED
Authorized Official - Last Name:NASSSER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:313-843-8300
Mailing Address - Street 1:PO BOX 4186
Mailing Address - Street 2:
Mailing Address - City:DEARBORN
Mailing Address - State:MI
Mailing Address - Zip Code:48126-0186
Mailing Address - Country:US
Mailing Address - Phone:313-843-8300
Mailing Address - Fax:
Practice Address - Street 1:9925 DIX STE 103
Practice Address - Street 2:
Practice Address - City:DEARBORN
Practice Address - State:MI
Practice Address - Zip Code:48120-1593
Practice Address - Country:US
Practice Address - Phone:313-843-8300
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ALI NASSER MD PC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-09-13
Last Update Date:2021-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301077843261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4627749Medicaid
MI1108227222OtherBLUE CROSS BLUR SHIELD
MI0N90890Medicare PIN
MI4627749Medicaid