Provider Demographics
NPI:1619460110
Name:RIDA, ALI (MD)
Entity type:Individual
Prefix:
First Name:ALI
Middle Name:
Last Name:RIDA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:23100 CHERRY HILL ST STE 9
Mailing Address - Street 2:
Mailing Address - City:DEARBORN
Mailing Address - State:MI
Mailing Address - Zip Code:48124-1449
Mailing Address - Country:US
Mailing Address - Phone:313-747-2007
Mailing Address - Fax:313-789-1596
Practice Address - Street 1:23100 CHERRY HILL ST STE 9
Practice Address - Street 2:
Practice Address - City:DEARBORN
Practice Address - State:MI
Practice Address - Zip Code:48124-1449
Practice Address - Country:US
Practice Address - Phone:313-747-2007
Practice Address - Fax:313-789-1596
Is Sole Proprietor?:Yes
Enumeration Date:2018-06-08
Last Update Date:2024-10-07
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI4351038258207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine