Healthcare Provider Details

I. General information

NPI: 1790730257
Provider Name (Legal Business Name): ALI M DAGHER M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/23/2006
Last Update Date: 11/03/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2012 MONROE ST STE # 105
DEARBORN MI
48124-2938
US

IV. Provider business mailing address

2012 MONROE ST STE # 105
DEARBORN MI
48124-2938
US

V. Phone/Fax

Practice location:
  • Phone: 313-278-2450
  • Fax: 313-278-2452
Mailing address:
  • Phone: 313-278-2450
  • Fax: 313-278-2452

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RR0500X
TaxonomyRheumatology Physician
License Number4301066833
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: