Provider Demographics
NPI:1477068310
Name:ALI, TARIK ATIF (DO)
Entity Type:Individual
Prefix:DR
First Name:TARIK
Middle Name:ATIF
Last Name:ALI
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
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Mailing Address - Street 1:15408 AUBURNDALE ST
Mailing Address - Street 2:
Mailing Address - City:LIVONIA
Mailing Address - State:MI
Mailing Address - Zip Code:48154-3128
Mailing Address - Country:US
Mailing Address - Phone:734-788-9466
Mailing Address - Fax:
Practice Address - Street 1:5901 W VERNOR HWY
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48209-2180
Practice Address - Country:US
Practice Address - Phone:313-554-4357
Practice Address - Fax:313-554-1565
Is Sole Proprietor?:Yes
Enumeration Date:2017-12-13
Last Update Date:2021-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5101025422207Q00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty