MEDICARE: DR. MOHAMMAD AZHAR ALI 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	208200000X	Plastic Surgery Physician	4301057064	MI

General Provider Information

NPI Number	:	1952385593
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MOHAMMAD AZHAR ALI MD

Provider Business Mailing Address
First Line	:	43940 WOODWARD AVE
Second Line	:	STE 100
City	:	BLOOMFIELD TOWNSHIP
State	:	MI
Zip	:	48302
Country	:	US
Telephone Number	:	248-335-7200
Fax Number	:	248-335-7726

Provider Business Practice Location Address
First Line	:	43940 WOODWARD AVE
Second Line	:	STE 100
City	:	BLOOMFIELD TOWNSHIP
State	:	MI
Zip	:	48302
Country	:	US
Telephone Number	:	248-335-7200
Fax Number	:	248-335-7726

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

Provider Enumeration Date	:	12/06/2005
Last Update Date	:	04/06/2015

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