Provider Demographics
NPI:1003816315
Name:ALI, SHAMIM (MD)
Entity Type:Individual
Prefix:DR
First Name:SHAMIM
Middle Name:
Last Name:ALI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:707 S FRY RD
Mailing Address - Street 2:SUITE 360
Mailing Address - City:KATY
Mailing Address - State:TX
Mailing Address - Zip Code:77450-2256
Mailing Address - Country:US
Mailing Address - Phone:281-599-9979
Mailing Address - Fax:281-599-3540
Practice Address - Street 1:707 S FRY RD
Practice Address - Street 2:SUITE 360
Practice Address - City:KATY
Practice Address - State:TX
Practice Address - Zip Code:77450-2256
Practice Address - Country:US
Practice Address - Phone:281-599-9979
Practice Address - Fax:281-599-3540
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-28
Last Update Date:2008-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL7642207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX7142667OtherAETNA
TX22369OtherMEMORIAL HERMANN HEALTHCARE
TX170793701Medicaid
TX8R6350OtherBCBS
TX8D1526Medicare PIN
TXH76796Medicare UPIN