Provider Demographics
NPI:1760665863
Name:ALI, OMAR (MD)
Entity Type:Individual
Prefix:
First Name:OMAR
Middle Name:
Last Name:ALI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:6050 GREENFIELD RD
Mailing Address - Street 2:SUITE 101
Mailing Address - City:DEARBORN
Mailing Address - State:MI
Mailing Address - Zip Code:48126-6004
Mailing Address - Country:US
Mailing Address - Phone:313-945-9000
Mailing Address - Fax:313-945-7500
Practice Address - Street 1:6050 GREENFIELD RD
Practice Address - Street 2:SUITE 101
Practice Address - City:DEARBORN
Practice Address - State:MI
Practice Address - Zip Code:48126-6004
Practice Address - Country:US
Practice Address - Phone:313-945-9000
Practice Address - Fax:313-945-7500
Is Sole Proprietor?:No
Enumeration Date:2007-12-11
Last Update Date:2014-03-26
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
TXP1039207RC0000X
MI4301101627207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease