Healthcare Provider Details

I. General information

NPI: 1053688952
Provider Name (Legal Business Name): ALI H DABAJA DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/20/2011
Last Update Date: 01/24/2020
Certification Date: 01/24/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

116 S DENWOOD ST
DEARBORN MI
48124-1310
US

IV. Provider business mailing address

DEPT 259301 P O BOX 67000
DETROIT MI
48267-2593
US

V. Phone/Fax

Practice location:
  • Phone: 734-266-2780
  • Fax: 734-466-9615
Mailing address:
  • Phone: 734-266-2780
  • Fax: 734-466-9615

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number5101020852
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code207RC0200X
TaxonomyCritical Care Medicine (Internal Medicine) Physician
License Number5101020852
License Number StateMI
# 3
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number66361
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: