Healthcare Provider Details

I. General information

NPI: 1801642533
Provider Name (Legal Business Name): ALI BAYDOUN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/24/2024
Last Update Date: 04/24/2024
Certification Date: 04/24/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4160 JOHN R ST STE 1017
DETROIT MI
48201-2017
US

IV. Provider business mailing address

1723 N VERNON ST
DEARBORN MI
48128-1117
US

V. Phone/Fax

Practice location:
  • Phone: 313-745-4123
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: