Provider Demographics
NPI:1013366368
Name:ALI, FATIMA (DO)
Entity Type:Individual
Prefix:MRS
First Name:FATIMA
Middle Name:
Last Name:ALI
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19600 E 39TH ST S
Mailing Address - Street 2:
Mailing Address - City:INDEPENDENCE
Mailing Address - State:MO
Mailing Address - Zip Code:64057-2301
Mailing Address - Country:US
Mailing Address - Phone:913-222-9779
Mailing Address - Fax:816-312-4380
Practice Address - Street 1:19550 E 39TH ST S STE 310
Practice Address - Street 2:
Practice Address - City:INDEPENDENCE
Practice Address - State:MO
Practice Address - Zip Code:64057-2306
Practice Address - Country:US
Practice Address - Phone:913-222-9779
Practice Address - Fax:816-698-7378
Is Sole Proprietor?:No
Enumeration Date:2016-06-08
Last Update Date:2024-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA291432207RC0200X, 207RP1001X
NJ25MB10558000207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
No207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine