Provider Demographics
NPI:1205955952
Name:ALI M DAGHER MD PC
Entity type:Organization
Organization Name:ALI M DAGHER MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ALI
Authorized Official - Middle Name:M
Authorized Official - Last Name:DAGHER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:313-278-2450
Mailing Address - Street 1:2012 MONROE ST
Mailing Address - Street 2:STE # 105
Mailing Address - City:DEARBORN
Mailing Address - State:MI
Mailing Address - Zip Code:48124-2938
Mailing Address - Country:US
Mailing Address - Phone:313-278-2450
Mailing Address - Fax:313-278-2452
Practice Address - Street 1:2012 MONROE ST
Practice Address - Street 2:STE # 106
Practice Address - City:DEARBORN
Practice Address - State:MI
Practice Address - Zip Code:48124-2938
Practice Address - Country:US
Practice Address - Phone:313-278-2450
Practice Address - Fax:313-278-2452
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-27
Last Update Date:2013-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301066833207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI110H233260OtherBCBS GROUP PRACTICE #
MI0N89860Medicare ID - Type Unspecified
MIE88927Medicare UPIN