Healthcare Provider Details

I. General information

NPI: 1053933119
Provider Name (Legal Business Name): ALI HASSAN JAWAD MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/12/2020
Last Update Date: 08/06/2026
Certification Date: 08/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

28592 ORCHARD LAKE RD STE 333
FARMINGTON HILLS MI
48334-2903
US

IV. Provider business mailing address

34020 7 MILE RD STE 101
LIVONIA MI
48152-3093
US

V. Phone/Fax

Practice location:
  • Phone: 855-785-1110
  • Fax: 248-282-0866
Mailing address:
  • Phone: 248-516-5016
  • Fax: 248-516-5017

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number4301508895
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number01096383A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: