Healthcare Provider Details

I. General information

NPI: 1730969056
Provider Name (Legal Business Name): ALI EJAZ MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/03/2023
Last Update Date: 06/01/2026
Certification Date: 06/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

401 S MAIN ST STE 241
AKRON OH
44311-1118
US

IV. Provider business mailing address

1100 REID PKWY REID HEALTH PAYOR ENROLLMENT
RICHMOND IN
47374-1157
US

V. Phone/Fax

Practice location:
  • Phone: 313-358-4381
  • Fax:
Mailing address:
  • Phone: 765-983-3000
  • Fax: 765-935-8592

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number01098247A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: