Provider Demographics
NPI:1093770257
Name:MEHDIRAD, ALI AKBAR (MD)
Entity Type:Individual
Prefix:DR
First Name:ALI
Middle Name:AKBAR
Last Name:MEHDIRAD
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 952273
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63195-2273
Mailing Address - Country:US
Mailing Address - Phone:314-432-2580
Mailing Address - Fax:314-432-0223
Practice Address - Street 1:777 S NEW BALLAS RD
Practice Address - Street 2:SUITE 300E
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63141-8705
Practice Address - Country:US
Practice Address - Phone:314-432-7839
Practice Address - Fax:314-432-4839
Is Sole Proprietor?:No
Enumeration Date:2006-04-19
Last Update Date:2009-07-13
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MOR5G76207RC0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0001XAllopathic & Osteopathic PhysiciansInternal MedicineClinical Cardiac Electrophysiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO431908828OtherTAX ID#
MOCH4229OtherRR MEDICARE GROUP#
MO505207209Medicaid
MO000013355Medicare ID - Type UnspecifiedGROUP PROVIDER#
MO505207209Medicaid