Provider Demographics
NPI:1770476400
Name:ALI, MAHAMED
Entity type:Individual
Prefix:
First Name:MAHAMED
Middle Name:
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 1:4070 S PACKARD AVE APT 14
Mailing Address - Street 2:
Mailing Address - City:SAINT FRANCIS
Mailing Address - State:WI
Mailing Address - Zip Code:53235-4845
Mailing Address - Country:US
Mailing Address - Phone:317-649-0760
Mailing Address - Fax:
Practice Address - Street 1:4070 S PACKARD AVE APT 14
Practice Address - Street 2:
Practice Address - City:SAINT FRANCIS
Practice Address - State:WI
Practice Address - Zip Code:53235-4845
Practice Address - Country:US
Practice Address - Phone:317-649-0760
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-06-02
Last Update Date:2025-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WIA400-5419-5105-011041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical