Provider Demographics
NPI:1225299647
Name:MOKHTARZADEH, ALI (MD)
Entity Type:Individual
Prefix:DR
First Name:ALI
Middle Name:
Last Name:MOKHTARZADEH
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:420 DELAWARE ST SE
Mailing Address - Street 2:MMC 493
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55455-0341
Mailing Address - Country:US
Mailing Address - Phone:612-625-4654
Mailing Address - Fax:612-626-3119
Practice Address - Street 1:420 DELAWARE ST SE
Practice Address - Street 2:MMC 493
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55455-0341
Practice Address - Country:US
Practice Address - Phone:612-625-4654
Practice Address - Fax:612-626-3119
Is Sole Proprietor?:No
Enumeration Date:2008-06-18
Last Update Date:2016-07-29
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MN55387207W00000X, 207WX0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207WX0200XAllopathic & Osteopathic PhysiciansOphthalmologyOphthalmic Plastic and Reconstructive Surgery
No207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN180001576Medicare PIN