Provider Demographics
NPI:1861135543
Name:DOURRA, ALI (DPM)
Entity type:Individual
Prefix:
First Name:ALI
Middle Name:
Last Name:DOURRA
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5300 HARROUN RD STE 201
Mailing Address - Street 2:
Mailing Address - City:SYLVANIA
Mailing Address - State:OH
Mailing Address - Zip Code:43560-2146
Mailing Address - Country:US
Mailing Address - Phone:419-885-5563
Mailing Address - Fax:
Practice Address - Street 1:5300 HARROUN RD STE 201
Practice Address - Street 2:
Practice Address - City:SYLVANIA
Practice Address - State:OH
Practice Address - Zip Code:43560-2146
Practice Address - Country:US
Practice Address - Phone:419-885-5563
Practice Address - Fax:419-885-5439
Is Sole Proprietor?:Yes
Enumeration Date:2022-04-19
Last Update Date:2025-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5951001469213ES0103X
OH36.004206213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery