Provider Demographics
NPI:1033780721
Name:ALI, KARRIEM (MD)
Entity Type:Individual
Prefix:
First Name:KARRIEM
Middle Name:
Last Name:ALI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:KARYEMAITRE
Other - Middle Name:
Other - Last Name:ALIFFE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 1207
Mailing Address - Street 2:
Mailing Address - City:TENINO
Mailing Address - State:WA
Mailing Address - Zip Code:98589-1207
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:4315 TACOMA AVE S
Practice Address - Street 2:
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98418-6646
Practice Address - Country:US
Practice Address - Phone:360-322-4816
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-07-05
Last Update Date:2021-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00032373207SG0201X, 208U00000X, 208VP0000X, 207LH0002X
261QR1100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207LH0002XAllopathic & Osteopathic PhysiciansAnesthesiologyHospice and Palliative Medicine
No207SG0201XAllopathic & Osteopathic PhysiciansMedical GeneticsClinical Genetics (M.D.)
No208U00000XAllopathic & Osteopathic PhysiciansClinical Pharmacology
No208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain Medicine
No261QR1100XAmbulatory Health Care FacilitiesClinic/CenterResearch