Provider Demographics
NPI:1053631457
Name:RKEIN, ALI M (MD)
Entity Type:Individual
Prefix:
First Name:ALI
Middle Name:M
Last Name:RKEIN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1688 E BOSTON ST #101
Mailing Address - Street 2:
Mailing Address - City:GILBERT
Mailing Address - State:AZ
Mailing Address - Zip Code:85295-6220
Mailing Address - Country:US
Mailing Address - Phone:480-855-0085
Mailing Address - Fax:480-855-0086
Practice Address - Street 1:1688 E BOSTON ST #101
Practice Address - Street 2:
Practice Address - City:GILBERT
Practice Address - State:AZ
Practice Address - Zip Code:85295-6220
Practice Address - Country:US
Practice Address - Phone:480-855-0085
Practice Address - Fax:480-855-0086
Is Sole Proprietor?:No
Enumeration Date:2010-06-08
Last Update Date:2023-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ48945207N00000X, 207ND0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
No207ND0101XAllopathic & Osteopathic PhysiciansDermatologyMOHS-Micrographic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ45945Medicaid
AZZ170863Medicare PIN