Provider Demographics
NPI:1225218381
Name:IMAN ALI MD PA
Entity Type:Organization
Organization Name:IMAN ALI MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN/OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:IMAN
Authorized Official - Middle Name:H
Authorized Official - Last Name:ALI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:817-685-8018
Mailing Address - Street 1:2036 BEDFORD RD
Mailing Address - Street 2:
Mailing Address - City:BEDFORD
Mailing Address - State:TX
Mailing Address - Zip Code:76021-5709
Mailing Address - Country:US
Mailing Address - Phone:817-685-8018
Mailing Address - Fax:817-685-9484
Practice Address - Street 1:2036 BEDFORD RD
Practice Address - Street 2:
Practice Address - City:BEDFORD
Practice Address - State:TX
Practice Address - Zip Code:76021-5709
Practice Address - Country:US
Practice Address - Phone:817-685-8018
Practice Address - Fax:817-685-9484
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-06
Last Update Date:2009-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX2017774Medicaid
TX00458MOtherMEDICARE GROUP PTAN NUMBER