Healthcare Provider Details

I. General information

NPI: 1942474127
Provider Name (Legal Business Name): ESA M ALI MD PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/17/2008
Last Update Date: 04/02/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2590 ELIZABETH LAKE RD
WATERFORD MI
48328-3314
US

IV. Provider business mailing address

2590 ELIZABETH LAKE RD
WATERFORD MI
48328-3314
US

V. Phone/Fax

Practice location:
  • Phone: 248-738-5500
  • Fax: 248-738-5506
Mailing address:
  • Phone: 248-738-5500
  • Fax: 248-738-5506

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberEA076578
License Number StateMI

VIII. Authorized Official

Name: ESA M ALI
Title or Position: PRESIDENT
Credential: MD
Phone: 248-738-5500