Healthcare Provider Details

I. General information

NPI: 1265835110
Provider Name (Legal Business Name): GHASSAN ALLO MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/07/2014
Last Update Date: 10/26/2023
Certification Date: 10/26/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2799 W GRAND BLVD HENRY FORD HOSPITAL, DEPT OF PATHOLOGY K-6
DETROIT MI
48202-2608
US

IV. Provider business mailing address

29155 NORTHWESTERN HWY # 442
SOUTHFIELD MI
48034-1011
US

V. Phone/Fax

Practice location:
  • Phone: 313-916-3214
  • Fax:
Mailing address:
  • Phone: 313-850-9345
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207ZP0101X
TaxonomyAnatomic Pathology Physician
License Number4301104425
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code207ZP0105X
TaxonomyClinical Pathology/Laboratory Medicine Physician
License Number4301104425
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: