Provider Demographics
NPI:1982635561
Name:ALI A FADEL MD PC
Entity Type:Organization
Organization Name:ALI A FADEL MD PC
Other - Org Name:BINGHAM MEDICAL CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:ALI
Authorized Official - Middle Name:A
Authorized Official - Last Name:FADEL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:313-581-4450
Mailing Address - Street 1:13244 W WARREN AVE
Mailing Address - Street 2:SUITE 1
Mailing Address - City:DEARBORN
Mailing Address - State:MI
Mailing Address - Zip Code:48126-1415
Mailing Address - Country:US
Mailing Address - Phone:313-581-4450
Mailing Address - Fax:313-581-7560
Practice Address - Street 1:13244 W WARREN AVE
Practice Address - Street 2:SUITE 1
Practice Address - City:DEARBORN
Practice Address - State:MI
Practice Address - Zip Code:48126-1415
Practice Address - Country:US
Practice Address - Phone:313-581-4450
Practice Address - Fax:313-581-7560
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-05
Last Update Date:2013-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI048691207Q00000X
MI207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI700H226120OtherBLUE CROSSS BLUE SHIELD
MI0P23410Medicare ID - Type Unspecified