Healthcare Provider Details

I. General information

NPI: 1013033976
Provider Name (Legal Business Name): M. AZHAR ALI MD PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/22/2007
Last Update Date: 07/30/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

353 S OLD WOODWARD AVE
BIRMINGHAM MI
48009
US

IV. Provider business mailing address

353 S OLD WOODWARD AVE
BIRMINGHAM MI
48009-6255
US

V. Phone/Fax

Practice location:
  • Phone: 248-335-7200
  • Fax: 248-335-7726
Mailing address:
  • Phone: 248-335-7200
  • Fax: 248-335-7726

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License NumberMA057064
License Number StateMI

VIII. Authorized Official

Name: JULIA CAROL SCHUETTE
Title or Position: PRACTICE MANAGER
Credential:
Phone: 248-335-7200