Provider Demographics
NPI:1831868512
Name:ALKALIBY, AHMED MOFREH ALI (MD)
Entity type:Individual
Prefix:
First Name:AHMED
Middle Name:MOFREH ALI
Last Name:ALKALIBY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2000 N HURON RIVER DR STE 100
Mailing Address - Street 2:
Mailing Address - City:YPSILANTI
Mailing Address - State:MI
Mailing Address - Zip Code:48197-1600
Mailing Address - Country:US
Mailing Address - Phone:734-572-1200
Mailing Address - Fax:
Practice Address - Street 1:860 E FRONT ST
Practice Address - Street 2:
Practice Address - City:TRAVERSE CITY
Practice Address - State:MI
Practice Address - Zip Code:49686-2704
Practice Address - Country:US
Practice Address - Phone:231-938-0710
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-09-07
Last Update Date:2024-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301507161207W00000X, 207WX0107X
OH35.143875207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
No207WX0107XAllopathic & Osteopathic PhysiciansOphthalmologyRetina Specialist