Healthcare Provider Details

I. General information

NPI: 1588787808
Provider Name (Legal Business Name): ALI HARB MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/10/2007
Last Update Date: 05/23/2022
Certification Date: 05/23/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3990 JOHN R ST
DETROIT MI
48201-2059
US

IV. Provider business mailing address

4201 SAINT ANTOINE ST # 3L-8
DETROIT MI
48201-2153
US

V. Phone/Fax

Practice location:
  • Phone: 313-745-8411
  • Fax:
Mailing address:
  • Phone: 313-745-4443
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0204X
TaxonomyVascular & Interventional Radiology Physician
License Number4301086148
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number4301086148
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: