Provider Demographics
NPI:1710181151
Name:ALI, MAMAN LAWAN (MD)
Entity Type:Individual
Prefix:DR
First Name:MAMAN
Middle Name:LAWAN
Last Name:ALI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:11819 MIRACLE HILLS DR STE 105
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68154-4428
Mailing Address - Country:US
Mailing Address - Phone:402-905-2075
Mailing Address - Fax:402-905-9864
Practice Address - Street 1:11819 MIRACLE HILLS DR STE 105
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68154-4428
Practice Address - Country:US
Practice Address - Phone:402-905-2075
Practice Address - Fax:402-905-9864
Is Sole Proprietor?:No
Enumeration Date:2007-06-11
Last Update Date:2017-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NETEP # 5214207Q00000X
NE25477207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA1710181151Medicaid
NE47068731789Medicaid
NE10026534900Medicaid
NE099099094Medicare PIN
IA1710181151Medicaid