Provider Demographics
NPI:1265954473
Name:MAHMOOD, ALI HIKMAT (MD)
Entity type:Individual
Prefix:
First Name:ALI
Middle Name:HIKMAT
Last Name:MAHMOOD
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:9850 HAGGERTY RD
Mailing Address - Street 2:
Mailing Address - City:VAN BUREN TWP
Mailing Address - State:MI
Mailing Address - Zip Code:48111-3443
Mailing Address - Country:US
Mailing Address - Phone:734-699-3080
Mailing Address - Fax:734-699-3946
Practice Address - Street 1:9850 HAGGERTY RD
Practice Address - Street 2:
Practice Address - City:VAN BUREN TWP
Practice Address - State:MI
Practice Address - Zip Code:48111-3443
Practice Address - Country:US
Practice Address - Phone:734-699-3080
Practice Address - Fax:734-699-3946
Is Sole Proprietor?:No
Enumeration Date:2017-07-10
Last Update Date:2021-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301113420207QG0300X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QG0300XAllopathic & Osteopathic PhysiciansFamily MedicineGeriatric Medicine
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine