Provider Demographics
NPI:1750430518
Name:ALI H MEHRAM, MD
Entity type:Organization
Organization Name:ALI H MEHRAM, MD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD
Authorized Official - Prefix:
Authorized Official - First Name:ALI
Authorized Official - Middle Name:H
Authorized Official - Last Name:MEHRAM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:313-928-3200
Mailing Address - Street 1:7940 ALLEN RD
Mailing Address - Street 2:
Mailing Address - City:ALLEN PARK
Mailing Address - State:MI
Mailing Address - Zip Code:48101-1704
Mailing Address - Country:US
Mailing Address - Phone:313-928-3200
Mailing Address - Fax:
Practice Address - Street 1:7940 ALLEN RD
Practice Address - Street 2:
Practice Address - City:ALLEN PARK
Practice Address - State:MI
Practice Address - Zip Code:48101-1704
Practice Address - Country:US
Practice Address - Phone:313-928-3200
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-10
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
0828084Medicare ID - Type Unspecified