Provider Demographics
NPI:1487863478
Name:ALLI MED PLLC
Entity Type:Organization
Organization Name:ALLI MED PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:MIRZA
Authorized Official - Middle Name:JAVED
Authorized Official - Last Name:HUSSAIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:989-790-2690
Mailing Address - Street 1:70 N FROST DR STE 4
Mailing Address - Street 2:
Mailing Address - City:SAGINAW
Mailing Address - State:MI
Mailing Address - Zip Code:48638-5796
Mailing Address - Country:US
Mailing Address - Phone:989-790-2690
Mailing Address - Fax:989-790-4759
Practice Address - Street 1:2213 N CENTER RD
Practice Address - Street 2:
Practice Address - City:SAGINAW
Practice Address - State:MI
Practice Address - Zip Code:48603-3730
Practice Address - Country:US
Practice Address - Phone:989-790-2690
Practice Address - Fax:989-790-4759
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-22
Last Update Date:2016-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301068966207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1780784934OtherNPI SINGLE PROVIDER
MI4792377Medicaid
MI4792377Medicaid