Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207P00000X | Emergency Physician | 5101020852 | MI |
Y | 207P00000X | Emergency Physician | 66361 | WI |
N | 207RC0200X | Critical Care Medicine | 5101020852 | MI |
NPI | 1053688952 |
---|---|
Provider Name | Ali H Dabaja |
First Address | Detroit, MI 48267-2593 |
Second Address | Dearborn, MI 48124-1310 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/11/2011 |
Last Update Date | 24/01/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1053688952 | (05) | MI |