Provider Demographics
NPI:1689426116
Name:ALI, MUBARAK
Entity Type:Individual
Prefix:MR
First Name:MUBARAK
Middle Name:
Last Name:ALI
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:TRINITY HEALTH LIVONIA HOSPITAL
Mailing Address - Street 2:36475 FIVE MILE RD
Mailing Address - City:LIVONIA
Mailing Address - State:MI
Mailing Address - Zip Code:48154
Mailing Address - Country:US
Mailing Address - Phone:734-655-2727
Mailing Address - Fax:734-655-8430
Practice Address - Street 1:TRINITY HEALTH ACADEMIC INTERNAL MEDICINE-NORTHWEST L
Practice Address - Street 2:37595SEVEN MILE RD., SUITE 340
Practice Address - City:LIVONIA
Practice Address - State:MI
Practice Address - Zip Code:48152
Practice Address - Country:US
Practice Address - Phone:734-793-2470
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-04-05
Last Update Date:2024-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training ProgramGroup - Single Specialty