Healthcare Provider Details

I. General information

NPI: 1457912818
Provider Name (Legal Business Name): HASSAN ALI MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/26/2019
Last Update Date: 04/01/2024
Certification Date: 04/01/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 NORTH AVE
BATTLE CREEK MI
49017-3307
US

IV. Provider business mailing address

255 W. MICHIGAN AVENUE PO BOX 1123
JACKSON MI
49201-2218
US

V. Phone/Fax

Practice location:
  • Phone: 269-245-3321
  • Fax:
Mailing address:
  • Phone: 517-787-6440
  • Fax: 517-787-4146

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number4301507571
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: