Provider Demographics
NPI:1417235227
Name:MAKKI, ALI YOUNES (MD)
Entity Type:Individual
Prefix:
First Name:ALI
Middle Name:YOUNES
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 1:550 LINCOLN LN
Mailing Address - Street 2:APARTMENT 2004
Mailing Address - City:DEARBORN
Mailing Address - State:MI
Mailing Address - Zip Code:48126-6114
Mailing Address - Country:US
Mailing Address - Phone:313-442-2982
Mailing Address - Fax:
Practice Address - Street 1:25325 FORD RD
Practice Address - Street 2:
Practice Address - City:DEARBORN
Practice Address - State:MI
Practice Address - Zip Code:48128-1086
Practice Address - Country:US
Practice Address - Phone:313-277-4146
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-27
Last Update Date:2015-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301099661207QS0010X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QS0010XAllopathic & Osteopathic PhysiciansFamily MedicineSports Medicine