Provider Demographics
NPI:1851877799
Name:AYESH, ALI SAMEH ALI (MD)
Entity Type:Individual
Prefix:
First Name:ALI
Middle Name:SAMEH ALI
Last Name:AYESH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4201 ST. , ANTOINE ST.
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48201
Mailing Address - Country:US
Mailing Address - Phone:313-745-5146
Mailing Address - Fax:
Practice Address - Street 1:4201 ST. , ANTOINE ST.
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48201
Practice Address - Country:US
Practice Address - Phone:313-745-5146
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-07-13
Last Update Date:2023-09-18
Deactivation Date:2019-02-13
Deactivation Code:
Reactivation Date:2019-04-01
Provider Licenses
StateLicense IDTaxonomies
390200000X
ND19413207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program