Provider Demographics
NPI:1497404669
Name:ALI, MUHAMMAD (SA-C)
Entity Type:Individual
Prefix:
First Name:MUHAMMAD
Middle Name:
Last Name:ALI
Suffix:
Gender:M
Credentials:SA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1720 COUNTRYSIDE DR
Mailing Address - Street 2:MUHAMMAD ALI
Mailing Address - City:SHAKOPEE
Mailing Address - State:MN
Mailing Address - Zip Code:55379
Mailing Address - Country:US
Mailing Address - Phone:845-901-5326
Mailing Address - Fax:
Practice Address - Street 1:1720 COUNTRYSIDE DR
Practice Address - Street 2:MUHAMMAD ALI
Practice Address - City:SHAKOPEE
Practice Address - State:MN
Practice Address - Zip Code:55379-5537
Practice Address - Country:US
Practice Address - Phone:845-901-5326
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-03-23
Last Update Date:2022-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL238.000522246ZC0007X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZC0007XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Assistant