Provider Demographics
NPI:1477513158
Name:NASSER, ALI MOHAMED (MD)
Entity Type:Individual
Prefix:DR
First Name:ALI
Middle Name:MOHAMED
Last Name:NASSER
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 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:313-843-8301
Practice Address - Street 1:9925 DIX
Practice Address - Street 2:SUITE 103
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:
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301077843207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4627749Medicaid
MII05961Medicare UPIN
MIN90890001Medicare ID - Type Unspecified