Provider Demographics
NPI:1821314956
Name:HUMA ALI MD PA
Entity Type:Organization
Organization Name:HUMA ALI MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:KRISTIN
Authorized Official - Middle Name:
Authorized Official - Last Name:BLASDELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:954-946-4539
Mailing Address - Street 1:1451 W CYPRESS CREEK RD
Mailing Address - Street 2:#357
Mailing Address - City:FORT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33309-1961
Mailing Address - Country:US
Mailing Address - Phone:954-946-4539
Mailing Address - Fax:
Practice Address - Street 1:8195 NW 105TH LN
Practice Address - Street 2:
Practice Address - City:PARKLAND
Practice Address - State:FL
Practice Address - Zip Code:33076-4763
Practice Address - Country:US
Practice Address - Phone:954-926-3155
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-04-14
Last Update Date:2010-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME89011207QG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207QG0300XAllopathic & Osteopathic PhysiciansFamily MedicineGeriatric MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLH99684Medicare UPIN