Provider Demographics
NPI:1457317547
Name:ALI, MICHAEL A (MD)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:A
Last Name:ALI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:3605 AGNETA CT
Mailing Address - Street 2:
Mailing Address - City:ELK GROVE
Mailing Address - State:CA
Mailing Address - Zip Code:95758-7408
Mailing Address - Country:US
Mailing Address - Phone:916-501-1500
Mailing Address - Fax:916-683-9605
Practice Address - Street 1:8325 ELK GROVE FLORIN RD
Practice Address - Street 2:SUITE 800
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95829-9523
Practice Address - Country:US
Practice Address - Phone:916-226-6190
Practice Address - Fax:916-689-5038
Is Sole Proprietor?:No
Enumeration Date:2006-04-26
Last Update Date:2023-04-06
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAA95471207P00000X, 207Q00000X
WAMD61351602207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A954710Medicaid
CA00A954710Medicare PIN
CA00A954711Medicare PIN
CA00A954713Medicare PIN