Provider Demographics
NPI:1952385593
Name:ALI, MOHAMMAD AZHAR (MD)
Entity Type:Individual
Prefix:DR
First Name:MOHAMMAD
Middle Name:AZHAR
Last Name:ALI
Suffix:
Gender:M
Credentials:MD
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Other - Credentials:
Mailing Address - Street 1:43940 WOODWARD AVE
Mailing Address - Street 2:STE 100
Mailing Address - City:BLOOMFIELD TOWNSHIP
Mailing Address - State:MI
Mailing Address - Zip Code:48302
Mailing Address - Country:US
Mailing Address - Phone:248-335-7200
Mailing Address - Fax:248-335-7726
Practice Address - Street 1:43940 WOODWARD AVE
Practice Address - Street 2:STE 100
Practice Address - City:BLOOMFIELD TOWNSHIP
Practice Address - State:MI
Practice Address - Zip Code:48302
Practice Address - Country:US
Practice Address - Phone:248-335-7200
Practice Address - Fax:248-335-7726
Is Sole Proprietor?:No
Enumeration Date:2005-12-06
Last Update Date:2015-04-06
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MI4301057064208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIMI2263001Medicare PIN
MIMI2262001Medicare PIN
F84397Medicare UPIN