Provider Demographics
NPI:1710756440
Name:ALI, IDIRIS SHARIF
Entity Type:Individual
Prefix:
First Name:IDIRIS
Middle Name:SHARIF
Last Name:ALI
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:71 CAVALIER BLVD STE 119
Mailing Address - Street 2:
Mailing Address - City:FLORENCE
Mailing Address - State:KY
Mailing Address - Zip Code:41042-5168
Mailing Address - Country:US
Mailing Address - Phone:502-821-4997
Mailing Address - Fax:
Practice Address - Street 1:71 CAVALIER BLVD STE 119
Practice Address - Street 2:
Practice Address - City:FLORENCE
Practice Address - State:KY
Practice Address - Zip Code:41042-5168
Practice Address - Country:US
Practice Address - Phone:502-821-4997
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-12-21
Last Update Date:2023-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY4497344600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes344600000XTransportation ServicesTaxi