Healthcare Provider Details

I. General information

NPI: 1871079194
Provider Name (Legal Business Name): ALIA Y KAZI MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/19/2018
Last Update Date: 01/14/2022
Certification Date: 01/14/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2888 W GRAND BLVD
DETROIT MI
48202-2612
US

IV. Provider business mailing address

7700 2ND AVE
DETROIT MI
48202-2477
US

V. Phone/Fax

Practice location:
  • Phone: 313-202-8660
  • Fax:
Mailing address:
  • Phone: 313-202-8660
  • Fax: 313-447-2892

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number2018018334
License Number StateMO
# 2
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number4301504493
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: