Provider Demographics
NPI:1407046345
Name:SHAHRIARI, ALI P (MD)
Entity Type:Individual
Prefix:DR
First Name:ALI
Middle Name:P
Last Name:SHAHRIARI
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 1:3001 NW 49TH AVE
Mailing Address - Street 2:SUITE 104
Mailing Address - City:LAUDERDALE LAKES
Mailing Address - State:FL
Mailing Address - Zip Code:33313-7266
Mailing Address - Country:US
Mailing Address - Phone:954-739-2273
Mailing Address - Fax:954-739-2742
Practice Address - Street 1:3001 NW 49TH AVE
Practice Address - Street 2:SUITE 104
Practice Address - City:LAUDERDALE LAKES
Practice Address - State:FL
Practice Address - Zip Code:33313-7266
Practice Address - Country:US
Practice Address - Phone:954-739-2273
Practice Address - Fax:954-739-2742
Is Sole Proprietor?:No
Enumeration Date:2007-07-26
Last Update Date:2013-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01063617A208G00000X
FLME116440208G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200877850Medicaid
INM400053489Medicare PIN