MEDICARE: ALI H. MAHMOOD, PLLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207QG0300X	Geriatric Medicine (Family Medicine) Physician

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	4301500957	OTHER	MI	MEDICAL LICENSE

General Provider Information

NPI Number	:	1306415021
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ALI H. MAHMOOD, PLLC

Provider Business Mailing Address
First Line	:	9850 HAGGERTY RD
Second Line	:
City	:	VAN BUREN TWP
State	:	MI
Zip	:	48111-3443
Country	:	US
Telephone Number	:	734-699-3080
Fax Number	:

Provider Business Practice Location Address
First Line	:	9850 HAGGERTY RD
Second Line	:
City	:	VAN BUREN TWP
State	:	MI
Zip	:	48111-3443
Country	:	US
Telephone Number	:	734-699-3080
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	ALI H MAHMOOD
Credential	:	MD
Telephone Number	:	734-699-3080

Provider Enumeration Date	:	06/18/2021
Last Update Date	:	06/18/2021

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