Healthcare Provider Details

I. General information

NPI: 1265008148
Provider Name (Legal Business Name): ALI OMARI MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/01/2021
Last Update Date: 07/29/2024
Certification Date: 07/29/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10000 TELEGRAPH RD STE 100
TAYLOR MI
48180-3330
US

IV. Provider business mailing address

3601 W 13 MILE RD
ROYAL OAK MI
48073-6712
US

V. Phone/Fax

Practice location:
  • Phone: 313-887-6000
  • Fax:
Mailing address:
  • Phone: 248-898-5000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number4351048484
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: