Healthcare Provider Details

I. General information

NPI: 1790825008
Provider Name (Legal Business Name): MUHAMMAD ALI DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/07/2007
Last Update Date: 04/22/2024
Certification Date: 04/22/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1221 PINE GROVE AVE PORT HURON HOSPITAL EMERGENCY DEPT
PORT HURON MI
48060-3511
US

IV. Provider business mailing address

27573 GATEWAY DR N APT # 202
FARMINGTON HILLS MI
48334-4936
US

V. Phone/Fax

Practice location:
  • Phone: 810-987-5000
  • Fax: 810-385-4933
Mailing address:
  • Phone: 248-225-8116
  • Fax: 248-352-1397

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number5101016042
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number5101016042
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: