Provider Demographics
NPI:1568401248
Name:ALI, RIAS (MD, FACC)
Entity Type:Individual
Prefix:
First Name:RIAS
Middle Name:
Last Name:ALI
Suffix:
Gender:M
Credentials:MD, FACC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4740 MILE STRETCH DR
Mailing Address - Street 2:
Mailing Address - City:HOLIDAY
Mailing Address - State:FL
Mailing Address - Zip Code:34690-4331
Mailing Address - Country:US
Mailing Address - Phone:727-943-5200
Mailing Address - Fax:727-943-5201
Practice Address - Street 1:4740 MILE STRETCH DR
Practice Address - Street 2:
Practice Address - City:HOLIDAY
Practice Address - State:FL
Practice Address - Zip Code:34690-4331
Practice Address - Country:US
Practice Address - Phone:727-943-5200
Practice Address - Fax:727-943-5201
Is Sole Proprietor?:No
Enumeration Date:2006-06-06
Last Update Date:2019-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME83454207R00000X, 207RI0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL13625OtherBCBS
FL263856800Medicaid
FLE6944AMedicare ID - Type Unspecified