Provider Demographics
NPI:1790195972
Name:ALI, DEK M I
Entity Type:Individual
Prefix:MR
First Name:DEK
Middle Name:M
Last Name:ALI
Suffix:I
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 1:419 CEDAR AVE S APT G284
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55454-1032
Mailing Address - Country:US
Mailing Address - Phone:612-532-9854
Mailing Address - Fax:
Practice Address - Street 1:419 CEDAR AVE S APT G284
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55454-1032
Practice Address - Country:US
Practice Address - Phone:612-532-9854
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-04-28
Last Update Date:2014-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide