Basic Information
| Provider Information | |||||||||
| NPI: | 1437413721 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | HAZIMEH | ||||||||
| FirstName: | ALI | ||||||||
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| Credential: | M.D | ||||||||
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| Mailing Information | |||||||||
| Address1: | 36123 SCHOOLCRAFT RD | ||||||||
| Address2: | |||||||||
| City: | LIVONIA | ||||||||
| State: | MI | ||||||||
| PostalCode: | 481501216 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7344640887 | ||||||||
| FaxNumber: | 7344020254 | ||||||||
| Practice Location | |||||||||
| Address1: | 7542 WYOMING ST | ||||||||
| Address2: | |||||||||
| City: | DEARBORN | ||||||||
| State: | MI | ||||||||
| PostalCode: | 481261690 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3134151515 | ||||||||
| FaxNumber: | 3136596394 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/02/2012 | ||||||||
| LastUpdateDate: | 11/15/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 11/15/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QU0200X | 802446128 | MI | N | 193200000X MULTI-SPECIALTY GROUP | Ambulatory Health Care Facilities | Clinic/Center | Urgent Care | 207R00000X | 4301101224 | MI | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
No ID Information.