Provider Demographics
NPI:1174187264
Name:ALI, AHSAN (MD)
Entity Type:Individual
Prefix:MR
First Name:AHSAN
Middle Name:
Last Name:ALI
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 1:1438 SOUTH GRAND BLVD, MONTELEONE HALL
Mailing Address - Street 2:
Mailing Address - City:ST. LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63104
Mailing Address - Country:US
Mailing Address - Phone:314-977-4830
Mailing Address - Fax:314-977-4876
Practice Address - Street 1:1438 SOUTH GRAND BLVD, MONTELEONE HALL
Practice Address - Street 2:
Practice Address - City:ST. LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63104
Practice Address - Country:US
Practice Address - Phone:314-977-4830
Practice Address - Fax:314-977-4876
Is Sole Proprietor?:No
Enumeration Date:2019-04-24
Last Update Date:2019-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program