Healthcare Provider Details

I. General information

NPI: 1326283581
Provider Name (Legal Business Name): ALI A FADEL MD, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/02/2008
Last Update Date: 12/02/2008
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 Code213E00000X
TaxonomyPodiatrist
License Number5901001432
License Number StateMI

VIII. Authorized Official

Name: DR. ALI A FADEL
Title or Position: PRESIDENT
Credential: MD
Phone: 313-581-4450