Provider Demographics
NPI:1881676088
Name:ALI, ESA M (MD)
Entity Type:Individual
Prefix:DR
First Name:ESA
Middle Name:M
Last Name:ALI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:2590 ELIZABETH LAKE RD
Mailing Address - Street 2:
Mailing Address - City:WATERFORD
Mailing Address - State:MI
Mailing Address - Zip Code:48328-3314
Mailing Address - Country:US
Mailing Address - Phone:248-738-5500
Mailing Address - Fax:248-738-5506
Practice Address - Street 1:2590 ELIZABETH LAKE RD
Practice Address - Street 2:
Practice Address - City:WATERFORD
Practice Address - State:MI
Practice Address - Zip Code:48328-3314
Practice Address - Country:US
Practice Address - Phone:248-738-5500
Practice Address - Fax:248-738-5506
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-15
Last Update Date:2013-11-17
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI4301076578207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0442264OtherBLUE CROSS BLUE SHIELD
MI4586673Medicaid
MI7364481OtherAETNA
MIH89371OtherHAP
MI16456OtherMCARE
MI080D410020OtherBLUE CROSS BLUE SHIELD
MI080D410020OtherBLUE CARE NETWORK
MI0995964OtherHEALTH PLUS
MI4527690Medicaid
MI080D410020OtherBLUE CHOICE
MI080D410020OtherCOMMUNITY BLUE PPO
MI1009018OtherMCLAREN HEALTH PLAN
MI1009018OtherHEALTH ADVANTAGE
MI1009018OtherMCLAREN HEALTH PLAN
MI7364481OtherAETNA
MI0995964OtherHEALTH PLUS