=====================================================
General NPI Number Information
=====================================================
NPI Number | 1841263746
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ALI H MEHRAM MD
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/10/2006
-----------------------------------------------------
Last Update Date | 07/08/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 7940 ALLEN RD
-----------------------------------------------------
City | ALLEN PARK
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 48101-1704
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 313-928-3200
-----------------------------------------------------
Fax | 313-928-0246
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 7940 ALLEN RD
-----------------------------------------------------
City | ALLEN PARK
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 48101-1704
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207V00000X
-----------------------------------------------------
Taxonomy Name | Obstetrics & Gynecology Physician
-----------------------------------------------------
License Number | 4301031246
-----------------------------------------------------
License Number State | MI
-----------------------------------------------------