Provider Demographics
NPI:1235234808
Name:SULTAN-ALI, IBRAHIM A (MD)
Entity Type:Individual
Prefix:DR
First Name:IBRAHIM
Middle Name:A
Last Name:SULTAN-ALI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:9692 WOODLAND VISTA DR
Mailing Address - Street 2:
Mailing Address - City:CORDOVA
Mailing Address - State:TN
Mailing Address - Zip Code:38018-3621
Mailing Address - Country:US
Mailing Address - Phone:865-776-7348
Mailing Address - Fax:901-255-2606
Practice Address - Street 1:890 MADISON AVE
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38103-3409
Practice Address - Country:US
Practice Address - Phone:901-515-3028
Practice Address - Fax:844-308-5077
Is Sole Proprietor?:No
Enumeration Date:2006-09-14
Last Update Date:2023-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN37191207RC0200X, 207RS0012X
TNMD37191207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
No207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
No207RS0012XAllopathic & Osteopathic PhysiciansInternal MedicineSleep Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN30011291Medicare PIN
I00208Medicare UPIN