Basic Information
| Provider Information | |||||||||
| NPI: | 1053688952 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | DABAJA | ||||||||
| FirstName: | ALI | ||||||||
| MiddleName: | H | ||||||||
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| Credential: | DO | ||||||||
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| Mailing Information | |||||||||
| Address1: | DEPT 259301 | ||||||||
| Address2: | P O BOX 67000 | ||||||||
| City: | DETROIT | ||||||||
| State: | MI | ||||||||
| PostalCode: | 482672593 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7342662780 | ||||||||
| FaxNumber: | 7344669615 | ||||||||
| Practice Location | |||||||||
| Address1: | 116 S DENWOOD ST | ||||||||
| Address2: | |||||||||
| City: | DEARBORN | ||||||||
| State: | MI | ||||||||
| PostalCode: | 481241310 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7342662780 | ||||||||
| FaxNumber: | 7344669615 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/20/2011 | ||||||||
| LastUpdateDate: | 01/24/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 01/24/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207P00000X | 5101020852 | MI | N | Allopathic & Osteopathic Physicians | Emergency Medicine | 207RC0200X | 5101020852 | MI | N | Allopathic & Osteopathic Physicians | Internal Medicine | Critical Care Medicine | 207P00000X | 66361 | WI | Y | Allopathic & Osteopathic Physicians | Emergency Medicine |
ID Information
| ID | Type | State | Issuer | Description | 1053688952 | 05 | MI | MEDICAID |