Provider Demographics
NPI:1578242038
Name:HAGE, ALI (MD, MPH, FRCSC)
Entity Type:Individual
Prefix:DR
First Name:ALI
Middle Name:
Last Name:HAGE
Suffix:
Gender:M
Credentials:MD, MPH, FRCSC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10001 CHESTER AVE APT 633
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44106-1639
Mailing Address - Country:US
Mailing Address - Phone:519-701-5559
Mailing Address - Fax:
Practice Address - Street 1:9500 EUCLID AVE # J4-133C1
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44195-0001
Practice Address - Country:US
Practice Address - Phone:216-645-4775
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-07-12
Last Update Date:2024-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
OH35.147540208G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program