Provider Demographics
NPI:1619905353
Name:MARDAN, ALI H (PHD, MD, RPVI, FACP)
Entity Type:Individual
Prefix:DR
First Name:ALI
Middle Name:H
Last Name:MARDAN
Suffix:
Gender:M
Credentials:PHD, MD, RPVI, FACP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1000 4TH ST SW
Mailing Address - Street 2:
Mailing Address - City:MASON CITY
Mailing Address - State:IA
Mailing Address - Zip Code:50401-2800
Mailing Address - Country:US
Mailing Address - Phone:641-428-8001
Mailing Address - Fax:651-428-6888
Practice Address - Street 1:1000 4TH ST SW
Practice Address - Street 2:
Practice Address - City:MASON CITY
Practice Address - State:IA
Practice Address - Zip Code:50401-2800
Practice Address - Country:US
Practice Address - Phone:641-428-8001
Practice Address - Fax:641-428-6160
Is Sole Proprietor?:No
Enumeration Date:2006-06-29
Last Update Date:2023-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA41248207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC315331Medicaid
SCAA38203640Medicare PIN
MNF35946Medicare UPIN
SCAA38207951Medicare PIN