Provider Demographics
NPI:1467270496
Name:AL-WISHAH, ALI
Entity type:Individual
Prefix:
First Name:ALI
Middle Name:
Last Name:AL-WISHAH
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6048 COOLIDGE ST
Mailing Address - Street 2:
Mailing Address - City:DEARBORN HEIGHTS
Mailing Address - State:MI
Mailing Address - Zip Code:48127-2863
Mailing Address - Country:US
Mailing Address - Phone:313-615-0080
Mailing Address - Fax:
Practice Address - Street 1:6048 COOLIDGE ST
Practice Address - Street 2:
Practice Address - City:DEARBORN HEIGHTS
Practice Address - State:MI
Practice Address - Zip Code:48127-2863
Practice Address - Country:US
Practice Address - Phone:313-615-0080
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-09-30
Last Update Date:2024-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
No251J00000XAgenciesNursing Care