Provider Demographics
NPI:1093397432
Name:ALI, AYOUB A
Entity Type:Individual
Prefix:
First Name:AYOUB
Middle Name:A
Last Name:ALI
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3405 WOODLAND AVE UNIT 10A
Mailing Address - Street 2:
Mailing Address - City:WEST DES MOINES
Mailing Address - State:IA
Mailing Address - Zip Code:50266-1914
Mailing Address - Country:US
Mailing Address - Phone:515-556-3567
Mailing Address - Fax:
Practice Address - Street 1:3405 WOODLAND AVE UNIT 10A
Practice Address - Street 2:
Practice Address - City:WEST DES MOINES
Practice Address - State:IA
Practice Address - Zip Code:50266-1914
Practice Address - Country:US
Practice Address - Phone:515-556-3567
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-04-26
Last Update Date:2021-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes172A00000XOther Service ProvidersDriverGroup - Single Specialty