Provider Demographics
NPI:1871126813
Name:ALI, GREGORY M (NP)
Entity type:Individual
Prefix:
First Name:GREGORY
Middle Name:M
Last Name:ALI
Suffix:
Gender:M
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13074 WOODRIDGE CIR
Mailing Address - Street 2:
Mailing Address - City:PLYMOUTH
Mailing Address - State:MI
Mailing Address - Zip Code:48170-3892
Mailing Address - Country:US
Mailing Address - Phone:313-587-1170
Mailing Address - Fax:
Practice Address - Street 1:26750 PROVIDENCE PKWY STE 120
Practice Address - Street 2:
Practice Address - City:NOVI
Practice Address - State:MI
Practice Address - Zip Code:48374-1211
Practice Address - Country:US
Practice Address - Phone:248-679-8000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-02-18
Last Update Date:2020-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704275669363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care