Healthcare Provider Details

I. General information

NPI: 1932596046
Provider Name (Legal Business Name): ALAULDEEN HASAN ALI M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/16/2015
Last Update Date: 07/03/2020
Certification Date: 07/03/2020
Deactivation Date: 11/18/2015
Reactivation Date: 03/22/2016

III. Provider practice location address

3111 ELECTRIC AVE
PORT HURON MI
48060-8127
US

IV. Provider business mailing address

172 S CARNEY DR APT 1
SAINT CLAIR MI
48079-5535
US

V. Phone/Fax

Practice location:
  • Phone: 810-985-8900
  • Fax:
Mailing address:
  • Phone: 605-553-1760
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry
License Number4301501206
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: