Provider Demographics
NPI:1831113414
Name:ALO MED PLLC
Entity Type:Organization
Organization Name:ALO MED PLLC
Other - Org Name:IDA FAMILY WELLNESS CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:LAYTH
Authorized Official - Middle Name:
Authorized Official - Last Name:MAOLOOD
Authorized Official - Suffix:
Authorized Official - Credentials:MD, FACP, FAAP
Authorized Official - Phone:734-322-3379
Mailing Address - Street 1:3160 LEWIS AVE
Mailing Address - Street 2:
Mailing Address - City:IDA
Mailing Address - State:MI
Mailing Address - Zip Code:48140-9703
Mailing Address - Country:US
Mailing Address - Phone:888-432-3621
Mailing Address - Fax:866-390-9167
Practice Address - Street 1:3160 LEWIS AVE
Practice Address - Street 2:
Practice Address - City:IDA
Practice Address - State:MI
Practice Address - Zip Code:48140-9703
Practice Address - Country:US
Practice Address - Phone:888-432-3621
Practice Address - Fax:866-390-9167
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-27
Last Update Date:2016-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301068044261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH9318741Medicare PIN
MI0N84040Medicare PIN