MEDICARE: ALI YOUNES MAKKI M.D.

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	207QS0010X	Sports Medicine (Family Medicine) Physician	4301099661	MI

General Provider Information

NPI Number	:	1417235227
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ALI YOUNES MAKKI M.D.

Provider Business Mailing Address
First Line	:	550 LINCOLN LN
Second Line	:	APARTMENT 2004
City	:	DEARBORN
State	:	MI
Zip	:	48126-6114
Country	:	US
Telephone Number	:	313-442-2982
Fax Number	:

Provider Business Practice Location Address
First Line	:	25325 FORD RD
Second Line	:
City	:	DEARBORN
State	:	MI
Zip	:	48128-1086
Country	:	US
Telephone Number	:	313-277-4146
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/27/2011
Last Update Date	:	10/14/2015

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