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General NPI Number Information
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NPI Number | 1275532905
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Entity Type | Organization
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Legal Business Name | ALI HASAN MAHMOOD MD PLC
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Dates
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Enumeration Date | 07/15/2005
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Last Update Date | 11/07/2024
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Provider Practice Location Address
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Address Line | 13031 CONANT ST
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City | DETROIT
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State | MI
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Zip | 48212-2361
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Country | US
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Telephone | 313-893-5490
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Fax | 313-893-5495
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Provider Business Mailing Address
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Address Line | 13031 CONANT ST
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City | DETROIT
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State | MI
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Zip | 48212-2361
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Country | US
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Telephone | 313-893-5490
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Fax | 313-561-0277
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Authorized Official
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Title or Position | OWNER/PHYSICIAN
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Name | DR. ALI H MAHMOOD
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Credential | MD
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Telephone | 313-893-5490
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | GP068359
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License Number State | MI
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Taxonomy #2
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | AM056507
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License Number State | MI
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