Healthcare Provider Details

I. General information

NPI: 1972467694
Provider Name (Legal Business Name): MICHIGAN PREVENTIVE CARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/16/2025
Last Update Date: 12/16/2025
Certification Date: 12/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

30425 INDUSTRIAL RD
LIVONIA MI
48150-2019
US

IV. Provider business mailing address

30425 INDUSTRIAL RD
LIVONIA MI
48150-2019
US

V. Phone/Fax

Practice location:
  • Phone: 313-903-1776
  • Fax: 570-243-0995
Mailing address:
  • Phone: 313-903-1776
  • Fax: 570-243-0995

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: ALI MEHIEDDINE NASSRI
Title or Position: NP
Credential:
Phone: 313-903-1776