=====================================================
General NPI Number Information
=====================================================
NPI Number | 1750430518
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ALI H MEHRAM, MD
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/10/2007
-----------------------------------------------------
Last Update Date | 08/22/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 7940 ALLEN RD
-----------------------------------------------------
City | ALLEN PARK
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 48101-1704
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 313-928-3200
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 7940 ALLEN RD
-----------------------------------------------------
City | ALLEN PARK
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 48101-1704
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 313-928-3200
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | MD
-----------------------------------------------------
Name | ALI H MEHRAM
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 313-928-3200
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207V00000X
-----------------------------------------------------
Taxonomy Name | Obstetrics & Gynecology Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------