Provider Demographics
NPI:1558651422
Name:ALI ELHORR MD PC
Entity Type:Organization
Organization Name:ALI ELHORR MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ALI
Authorized Official - Middle Name:
Authorized Official - Last Name:ELHORR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:313-304-6515
Mailing Address - Street 1:12740 W WARREN AVE
Mailing Address - Street 2:STE 102, PMB 222
Mailing Address - City:DEARBORN
Mailing Address - State:MI
Mailing Address - Zip Code:48126-4530
Mailing Address - Country:US
Mailing Address - Phone:313-304-6515
Mailing Address - Fax:866-330-9327
Practice Address - Street 1:5728 SCHAEFER RD
Practice Address - Street 2:SUITE 103 FIRST FLOOR
Practice Address - City:DEARBORN
Practice Address - State:MI
Practice Address - Zip Code:48126-2298
Practice Address - Country:US
Practice Address - Phone:313-846-7987
Practice Address - Fax:888-304-1293
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-04-13
Last Update Date:2012-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301080821208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIMI4533Medicare PIN