Provider Demographics
NPI:1558694539
Name:ALI, RAO K (MD)
Entity Type:Individual
Prefix:
First Name:RAO
Middle Name:K
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 1:1609 ENCLAVE CT
Mailing Address - Street 2:
Mailing Address - City:SOUTHLAKE
Mailing Address - State:TX
Mailing Address - Zip Code:76092-3461
Mailing Address - Country:US
Mailing Address - Phone:732-610-6120
Mailing Address - Fax:
Practice Address - Street 1:405 W CAMPBELL RD
Practice Address - Street 2:SUITE 305
Practice Address - City:RICHARDSON
Practice Address - State:TX
Practice Address - Zip Code:75080-3468
Practice Address - Country:US
Practice Address - Phone:469-562-4188
Practice Address - Fax:469-562-4166
Is Sole Proprietor?:Yes
Enumeration Date:2009-09-09
Last Update Date:2022-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35.095398207LP2900X, 2081P2900X
TXR22662081P2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2081P2900XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationPain Medicine
No207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
654741OtherMEDICARE PTAN
654741OtherMEDICARE PTAN