Healthcare Provider Details

I. General information

NPI: 1922816784
Provider Name (Legal Business Name): ABIZER ALI PT, APRN, AGNP-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/26/2024
Last Update Date: 12/13/2025
Certification Date: 12/13/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21999 FARMINGTON RD STE 200
FARMINGTON MI
48336-4420
US

IV. Provider business mailing address

29983 CLUB HOUSE LN
FARMINGTON HILLS MI
48334-2019
US

V. Phone/Fax

Practice location:
  • Phone: 248-522-7258
  • Fax: 248-522-7289
Mailing address:
  • Phone: 248-757-0100
  • Fax: 248-757-0200

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number4704367708
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License Number4704367708
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: