Healthcare Provider Details

I. General information

NPI: 1154385870
Provider Name (Legal Business Name): MOHAMADALI H AMLANI M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/12/2006
Last Update Date: 09/29/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1165 S LINDEN RD
FLINT MI
48532-3406
US

IV. Provider business mailing address

14059 SWANEE BEACH DR
FENTON MI
48430-1468
US

V. Phone/Fax

Practice location:
  • Phone: 810-732-5400
  • Fax: 810-733-1624
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License NumberMI4301038827
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: