Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213ES0103X | Foot & Ankle Surgery | 5951001348 | MI |
NPI | 1053971390 |
---|---|
Provider Name | Jarred Ali |
First Address | Trenton, MI 48183-4601 |
Second Address | Trenton, MI 48183-4601 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/06/2019 |
Last Update Date | 18/06/2019 |