Provider Demographics
NPI:1336310838
Name:MADAD ALI, MD
Entity Type:Organization
Organization Name:MADAD ALI, MD
Other - Org Name:ALFA DIGESTIVE DISEASE CENTER
Other - Org Type:Other Name
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:MADAD
Authorized Official - Middle Name:
Authorized Official - Last Name:ALI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:573-785-7475
Mailing Address - Street 1:PO BOX 216
Mailing Address - Street 2:
Mailing Address - City:POPLAR BLUFF
Mailing Address - State:MO
Mailing Address - Zip Code:63902-0216
Mailing Address - Country:US
Mailing Address - Phone:573-785-7475
Mailing Address - Fax:573-785-6555
Practice Address - Street 1:2520 LUCY LEE PKWY
Practice Address - Street 2:
Practice Address - City:POPLAR BLUFF
Practice Address - State:MO
Practice Address - Zip Code:63901-2436
Practice Address - Country:US
Practice Address - Phone:573-785-7475
Practice Address - Fax:573-785-6555
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-12
Last Update Date:2008-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2002027101207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO2060127010Medicaid