Provider Demographics
NPI:1184689549
Name:ZIAEE, ALI (MD)
Entity Type:Individual
Prefix:
First Name:ALI
Middle Name:
Last Name:ZIAEE
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 1:11125 DUNN RD
Mailing Address - Street 2:SUITE 204
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63136-6132
Mailing Address - Country:US
Mailing Address - Phone:314-839-5522
Mailing Address - Fax:314-839-5351
Practice Address - Street 1:11125 DUNN RD
Practice Address - Street 2:SUITE 204
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63136-6132
Practice Address - Country:US
Practice Address - Phone:314-839-5522
Practice Address - Fax:314-839-5351
Is Sole Proprietor?:No
Enumeration Date:2006-04-19
Last Update Date:2021-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036-113041207RC0000X
MO110457207RI0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
021303OtherFMH
MO204891014Medicaid
MOP00319257OtherMORRMCR
ILP00341378OtherILRRMCR
MO126694OtherBC/BS
452274OtherHEALTHLINK
431098908OtherAETNA
H14925OtherMERCY
ILK28063Medicare PIN
H14925OtherMERCY
MO204891014Medicaid
MO012010900Medicare PIN
021303OtherFMH
MO012010452Medicare PIN