Basic Information
| Provider Information | |||||||||
| NPI: | 1548635121 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | ALI ENDOCRINOLOGY PC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1107 STONE ST | ||||||||
| Address2: | STE 3 | ||||||||
| City: | PORT HURON | ||||||||
| State: | MI | ||||||||
| PostalCode: | 480603569 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8108412282 | ||||||||
| FaxNumber: | 8109856221 | ||||||||
| Practice Location | |||||||||
| Address1: | 1107 STONE ST | ||||||||
| Address2: | STE 3 | ||||||||
| City: | PORT HURON | ||||||||
| State: | MI | ||||||||
| PostalCode: | 480603569 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8108412282 | ||||||||
| FaxNumber: | 8109856221 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/07/2015 | ||||||||
| LastUpdateDate: | 12/07/2015 | ||||||||
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| AuthorizedOfficialLastName: | HERNDEN | ||||||||
| AuthorizedOfficialFirstName: | KIMBERLY | ||||||||
| AuthorizedOfficialMiddleName: | M | ||||||||
| AuthorizedOfficialTitleorPosition: | CREDENTIALING | ||||||||
| AuthorizedOfficialTelephone: | 8107654750 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | MEDICAL BILLER | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RE0101X | 4301101847 | MI | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine | Endocrinology, Diabetes & Metabolism |
No ID Information.