Healthcare Provider Details

I. General information

NPI: 1740147214
Provider Name (Legal Business Name): ALI ALYASIRY
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/07/2026
Last Update Date: 01/07/2026
Certification Date: 01/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5534 WILLIAMSON ST
DEARBORN MI
48126-5003
US

IV. Provider business mailing address

5534 WILLIAMSON ST
DEARBORN MI
48126-5003
US

V. Phone/Fax

Practice location:
  • Phone: 313-401-7761
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: