Healthcare Provider Details

I. General information

NPI: 1730083429
Provider Name (Legal Business Name): ALISAR IBRAHIM FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/06/2026
Last Update Date: 10/06/2026
Certification Date: 10/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9800 CONANT ST
HAMTRAMCK MI
48212-3309
US

IV. Provider business mailing address

5470 GRINDLEY PARK ST
DEARBORN HEIGHTS MI
48125-2341
US

V. Phone/Fax

Practice location:
  • Phone: 313-424-4449
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number4704410138
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: