Provider Demographics
NPI:1437178753
Name:ALI, SHAGUFTA NAZ (MD)
Entity Type:Individual
Prefix:
First Name:SHAGUFTA
Middle Name:NAZ
Last Name:ALI
Suffix:
Gender:F
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:G3200 BEECHER RD STE O2
Mailing Address - Street 2:
Mailing Address - City:FLINT
Mailing Address - State:MI
Mailing Address - Zip Code:48532-3613
Mailing Address - Country:US
Mailing Address - Phone:810-342-2534
Mailing Address - Fax:
Practice Address - Street 1:G3200 BEECHER RD STE 2
Practice Address - Street 2:
Practice Address - City:FLINT
Practice Address - State:MI
Practice Address - Zip Code:48532-3651
Practice Address - Country:US
Practice Address - Phone:810-342-5515
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-18
Last Update Date:2022-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301082394207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI11OB561250OtherBCBSM COM BLUE CHOICE
MA4893191Medicaid
MI1021094OtherHAN MHP
MICA5169 PO03272814OtherMETRAHEALTH
MA4893191Medicaid