Provider Demographics
NPI:1568490670
Name:ALI, MIR I (MD)
Entity Type:Individual
Prefix:DR
First Name:MIR
Middle Name:I
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 1:6626 E 75TH ST
Mailing Address - Street 2:SUITE 500
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46250-2890
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:8075 N SHADELAND AVE
Practice Address - Street 2:STE 200
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46250-2693
Practice Address - Country:US
Practice Address - Phone:317-621-8640
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-29
Last Update Date:2024-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101239608207RC0000X
IN01063192A207RC0000X, 207RI0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA010273331Medicaid
IN200858830AMedicaid
INP01512396OtherMEDICARE RAILROAD PTAN
VA2147652OtherMAMSI
INP00387869OtherMEDICARE RAILROAD
NC5903821Medicaid
VA196861OtherANTHEM BCBS
IN266180545Medicare PIN
IN208790014Medicare PIN
INP01512396OtherMEDICARE RAILROAD PTAN
INM22404030Medicare PIN
IN465610KKKMedicare PIN
NC5903821Medicaid