Provider Demographics
NPI:1275532905
Name:ALI HASAN MAHMOOD MD PLC
Entity type:Organization
Organization Name:ALI HASAN MAHMOOD MD PLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER/PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:ALI
Authorized Official - Middle Name:H
Authorized Official - Last Name:MAHMOOD
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:313-893-5490
Mailing Address - Street 1:13031 CONANT ST
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48212-2361
Mailing Address - Country:US
Mailing Address - Phone:313-893-5490
Mailing Address - Fax:313-561-0277
Practice Address - Street 1:13031 CONANT ST
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48212-2361
Practice Address - Country:US
Practice Address - Phone:313-893-5490
Practice Address - Fax:313-893-5495
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-15
Last Update Date:2024-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIGP068359207Q00000X
MIAM056507207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1275532905Medicaid
MI615861800OtherDEPT OF LABOR
MI700H215230OtherBC
MI4283129Medicaid
MIDA2203OtherRAILROAD MEDICARE
MI700H215230OtherBCN
MI0P02840Medicare PIN
MI700H215230OtherBC