Provider Demographics
NPI:1841216066
Name:EHSANI, ALI A (MD)
Entity Type:Individual
Prefix:DR
First Name:ALI
Middle Name:A
Last Name:EHSANI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:915 N GRAND BLVD
Mailing Address - Street 2:CARDIOLOGY DIVISION, ROOM C219 BLDG 1
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63106-1621
Mailing Address - Country:US
Mailing Address - Phone:314-289-6309
Mailing Address - Fax:314-289-7029
Practice Address - Street 1:915 N GRAND BLVD
Practice Address - Street 2:CARDIOLOGY DIVISION, BLDG 1 ROOM C219
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63106-1621
Practice Address - Country:US
Practice Address - Phone:314-289-6309
Practice Address - Fax:314-289-7029
Is Sole Proprietor?:No
Enumeration Date:2006-07-14
Last Update Date:2008-05-19
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MOR7158207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
26569OtherMO-BLUE SHIELD
MO201013000Medicaid
26569OtherMO-BLUE SHIELD
033010183Medicare ID - Type Unspecified