Provider Demographics
NPI:1881629723
Name:ALI, NASIR (MD)
Entity Type:Individual
Prefix:DR
First Name:NASIR
Middle Name:
Last Name:ALI
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 1:11554 HIGHLAND RD
Mailing Address - Street 2:
Mailing Address - City:HARTLAND
Mailing Address - State:MI
Mailing Address - Zip Code:48353-2711
Mailing Address - Country:US
Mailing Address - Phone:810-632-0086
Mailing Address - Fax:810-222-0572
Practice Address - Street 1:1021 KARL GREIMEL DR STE 102
Practice Address - Street 2:
Practice Address - City:BRIGHTON
Practice Address - State:MI
Practice Address - Zip Code:48116
Practice Address - Country:US
Practice Address - Phone:810-225-0086
Practice Address - Fax:810-225-0286
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-11
Last Update Date:2018-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI43069965207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI462069510Medicaid
MIP18920003Medicare ID - Type Unspecified