MEDICARE: DR. MOHAMMAD GHALI MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208000000X	Pediatrics Physician	4301057489	MI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1023014610
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MOHAMMAD GHALI MD

Provider Business Mailing Address
First Line	:	505 N JACKSON ST
Second Line	:
City	:	JACKSON
State	:	MI
Zip	:	49201-1266
Country	:	US
Telephone Number	:	517-748-5500
Fax Number	:	517-780-9286

Provider Business Practice Location Address
First Line	:	5700 MONROE STREET
Second Line	:	WUITE 301
City	:	SYLVANIA
State	:	OH
Zip	:	43560-2737
Country	:	US
Telephone Number	:	419-291-2121
Fax Number	:	419-479-6017

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/28/2005
Last Update Date	:	11/03/2023

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