Provider Demographics
NPI:1154385870
Name:AMLANI, MOHAMADALI H (MD)
Entity type:Individual
Prefix:MR
First Name:MOHAMADALI
Middle Name:H
Last Name:AMLANI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14059 SWANEE BEACH DR
Mailing Address - Street 2:
Mailing Address - City:FENTON
Mailing Address - State:MI
Mailing Address - Zip Code:48430-1468
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1165 S LINDEN RD
Practice Address - Street 2:
Practice Address - City:FLINT
Practice Address - State:MI
Practice Address - Zip Code:48532-3406
Practice Address - Country:US
Practice Address - Phone:810-732-5400
Practice Address - Fax:810-733-1624
Is Sole Proprietor?:No
Enumeration Date:2006-04-12
Last Update Date:2011-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIMI4301038827174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1100341OtherHEALTH PLUS PARTNERS
MI1100341OtherHEALTH PLUS OF MICHIGAN
MIP00137361OtherRAILROAD MEDICARE
MI1010891OtherMCLAREN HEALTH PLAN
MI4591762Medicaid
MI0B51240OtherBLUE CROSS BLUE SHIELD MI
C2275OtherMCARE
MI0B51240, MA038827OtherBLUE CARE NETWORK
MI1010891OtherMCLAREN HEALTH ADVANTAGE
MI0B51240, MA038827OtherBLUE CARE NETWORK
MIN88450001Medicare ID - Type Unspecified