Provider Demographics
NPI:1548827181
Name:ALI, MOHAMMED FAROUG ELAMIN
Entity type:Individual
Prefix:
First Name:MOHAMMED
Middle Name:FAROUG ELAMIN
Last Name:ALI
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:MEDICAL EDUCATION
Mailing Address - Street 2:4201 ST. ANTOINE UHC 9C DETROIT
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48201
Mailing Address - Country:US
Mailing Address - Phone:313-966-0463
Mailing Address - Fax:313-966-0880
Practice Address - Street 1:MEDICAL EDUCATION
Practice Address - Street 2:4201 ST. ANTOINE UHC 9C DETROIT
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48201
Practice Address - Country:US
Practice Address - Phone:313-966-0463
Practice Address - Fax:313-966-0880
Is Sole Proprietor?:No
Enumeration Date:2019-05-20
Last Update Date:2019-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program