Healthcare Provider Details

I. General information

NPI: 1023500840
Provider Name (Legal Business Name): ALI BAYDOUN DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/06/2018
Last Update Date: 06/22/2026
Certification Date: 06/22/2026
Deactivation Date: 05/09/2023
Reactivation Date: 05/30/2023

III. Provider practice location address

25350 W WARREN ST
DEARBORN HEIGHTS MI
48127-2102
US

IV. Provider business mailing address

28050 GRAND RIVER AVE
FARMINGTON HILLS MI
48336-5919
US

V. Phone/Fax

Practice location:
  • Phone: 313-914-3666
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number5151016218
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code156F00000X
TaxonomyTechnician/Technologist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: