Healthcare Provider Details

I. General information

NPI: 1003975517
Provider Name (Legal Business Name): HADI ALI DOURRA M.D
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/08/2006
Last Update Date: 10/28/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

27144 JOY RD
REDFORD MI
48239-2368
US

IV. Provider business mailing address

27144 JOY RD
REDFORD MI
48239-2368
US

V. Phone/Fax

Practice location:
  • Phone: 313-937-1400
  • Fax: 313-937-1402
Mailing address:
  • Phone: 313-937-1400
  • Fax: 313-937-1402

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number4301084360
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number4301084360
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: