Provider Demographics
NPI:1376564815
Name:ALI, MADAD (MD)
Entity Type:Individual
Prefix:DR
First Name:MADAD
Middle Name:
Last Name:ALI
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 1:7200 CAMBRIDGE ST FL 8
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77030-4202
Mailing Address - Country:US
Mailing Address - Phone:713-798-3503
Mailing Address - Fax:
Practice Address - Street 1:1504 TAUB LOOP
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77030-1608
Practice Address - Country:US
Practice Address - Phone:713-873-8890
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-21
Last Update Date:2023-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX47868207R00000X, 207RG0100X
TX99999207R00000X, 207RG0100X
MO2002027101207RG0100X
TXU2767207RG0100X, 207R00000X
NY121321207RG0100X
IL036140847207RG0100X
NJ25MA03726400207RG0100X
PAMD451324207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA103215762Medicaid
MO206012700Medicaid
MO174360OtherALLIANCE BLUE CROSS BLUE SHIELD
MO174360OtherALLIANCE BLUE CROSS BLUE SHIELD
MO206012700Medicaid