Provider Demographics
NPI:1497315931
Name:DAHER, ALI HUSSEIN (DO)
Entity Type:Individual
Prefix:DR
First Name:ALI
Middle Name:HUSSEIN
Last Name:DAHER
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:28100 GRAND RIVER AVE STE 313
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48336-5970
Mailing Address - Country:US
Mailing Address - Phone:248-615-7150
Mailing Address - Fax:
Practice Address - Street 1:17000 HUBBARD DR
Practice Address - Street 2:
Practice Address - City:DEARBORN
Practice Address - State:MI
Practice Address - Zip Code:48126-4258
Practice Address - Country:US
Practice Address - Phone:313-982-4351
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-06-17
Last Update Date:2022-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5151013515207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine