Healthcare Provider Details

I. General information

NPI: 1831415314
Provider Name (Legal Business Name): ALI NASSER MD PC2
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/09/2010
Last Update Date: 04/09/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9800 CONANT ST SUITE C
HAMTRAMCK MI
48212-3309
US

IV. Provider business mailing address

9800 CONANT SUITE C
HAMTRAMCK MI
48212
US

V. Phone/Fax

Practice location:
  • Phone: 313-875-9000
  • Fax: 313-875-9021
Mailing address:
  • Phone: 313-875-9000
  • Fax: 313-875-9021

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code173000000X
TaxonomyLegal Medicine
License Number4301077843
License Number StateMI

VIII. Authorized Official

Name: DR. ALI NASSER
Title or Position: PHYSICIAN
Credential: MD
Phone: 313-875-9000