Provider Demographics
NPI:1578678819
Name:ALI M ALSAADI MD PC
Entity type:Organization
Organization Name:ALI M ALSAADI MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ALI
Authorized Official - Middle Name:M
Authorized Official - Last Name:ALSAADI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:248-535-2606
Mailing Address - Street 1:24353 ORCHARD LAKE RD STE D
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48336-1917
Mailing Address - Country:US
Mailing Address - Phone:248-200-3715
Mailing Address - Fax:248-200-3717
Practice Address - Street 1:24353 ORCHARD LAKE RD STE D
Practice Address - Street 2:
Practice Address - City:FARMINGTON HILLS
Practice Address - State:MI
Practice Address - Zip Code:48336-1917
Practice Address - Country:US
Practice Address - Phone:248-200-3715
Practice Address - Fax:248-200-3717
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-19
Last Update Date:2024-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIAA082560207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1106356302OtherBLUE CARE NETWORK
MI4883328Medicaid
MI110F339630OtherBCBSM
MI157283OtherGREAT LAKES HEALTH PLAN
MI=========OtherTAX ID
MI0P35400Medicare ID - Type Unspecified
MI157283OtherGREAT LAKES HEALTH PLAN