Healthcare Provider Details

I. General information

NPI: 1982635561
Provider Name (Legal Business Name): ALI A FADEL MD PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/05/2006
Last Update Date: 08/13/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13244 W WARREN AVE SUITE 1
DEARBORN MI
48126-1415
US

IV. Provider business mailing address

13244 W WARREN AVE SUITE 1
DEARBORN MI
48126-1415
US

V. Phone/Fax

Practice location:
  • Phone: 313-581-4450
  • Fax: 313-581-7560
Mailing address:
  • Phone: 313-581-4450
  • Fax: 313-581-7560

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number048691
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number StateMI

VIII. Authorized Official

Name: MR. ALI A FADEL
Title or Position: PRESIDENT
Credential: M.D.
Phone: 313-581-4450