Healthcare Provider Details

I. General information

NPI: 1841984648
Provider Name (Legal Business Name): ALI AL-WAILI MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/05/2023
Last Update Date: 08/27/2026
Certification Date: 08/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 HEALTH PARK DR STE 201
OWOSSO MI
48867-1291
US

IV. Provider business mailing address

200 HEALTH PARK DR STE 201
OWOSSO MI
48867-1291
US

V. Phone/Fax

Practice location:
  • Phone: 989-723-8666
  • Fax: 989-725-1434
Mailing address:
  • Phone: 989-723-8666
  • Fax: 989-725-1434

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number4301517918
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: