Provider Demographics
NPI:1780632109
Name:ALI, HASSAN (MD)
Entity Type:Individual
Prefix:
First Name:HASSAN
Middle Name:
Last Name:ALI
Suffix:
Gender:M
Credentials:MD
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Other - First Name:
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Mailing Address - Street 1:7100 PINES BLVD
Mailing Address - Street 2:SUITE 23
Mailing Address - City:PEMBROKE PINES
Mailing Address - State:FL
Mailing Address - Zip Code:33024-7355
Mailing Address - Country:US
Mailing Address - Phone:954-967-0100
Mailing Address - Fax:954-967-0109
Practice Address - Street 1:3661 S MIAMI AVE
Practice Address - Street 2:SUITE 402
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33133-4236
Practice Address - Country:US
Practice Address - Phone:305-858-3430
Practice Address - Fax:305-858-6950
Is Sole Proprietor?:No
Enumeration Date:2006-05-05
Last Update Date:2024-03-25
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
FLME 58410207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL251829500Medicaid
FLF87720Medicare UPIN