Provider Demographics
NPI:1639873243
Name:ALIY, MISKI MUNIR
Entity Type:Individual
Prefix:
First Name:MISKI
Middle Name:MUNIR
Last Name:ALIY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1613 128TH LN NW
Mailing Address - Street 2:
Mailing Address - City:COON RAPIDS
Mailing Address - State:MN
Mailing Address - Zip Code:55448-1573
Mailing Address - Country:US
Mailing Address - Phone:612-446-1989
Mailing Address - Fax:
Practice Address - Street 1:1613 128TH LN NW
Practice Address - Street 2:
Practice Address - City:COON RAPIDS
Practice Address - State:MN
Practice Address - Zip Code:55448-1573
Practice Address - Country:US
Practice Address - Phone:612-446-1989
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-03-28
Last Update Date:2023-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305R00000XManaged Care OrganizationsPreferred Provider Organization