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General NPI Number Information
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NPI Number | 1578355392
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Entity Type | Individual
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Provider Name | AGHA WALI
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Gender | Male
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Dates
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Enumeration Date | 05/19/2025
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Last Update Date | 05/19/2025
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Provider Practice Location Address
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Address Line | 3901 BEAUBIEN ST
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City | DETROIT
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State | MI
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Zip | 48201-2196
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Country | US
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Telephone | 313-745-5437
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Fax |
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Provider Business Mailing Address
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Address Line | 2032 W ASTER DR
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City | PHOENIX
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State | AZ
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Zip | 85029-2606
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Country | US
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Telephone | 412-535-3884
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2080P0210X
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Taxonomy Name | Pediatric Nephrology Physician
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License Number | 0000
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License Number State | MI
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