Provider Demographics
NPI:1851340129
Name:ALI, MIR S (MD)
Entity Type:Individual
Prefix:
First Name:MIR
Middle Name:S
Last Name:ALI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1710 BRIARWYCK DR
Mailing Address - Street 2:
Mailing Address - City:BROWNSVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:78520-9262
Mailing Address - Country:US
Mailing Address - Phone:956-350-6144
Mailing Address - Fax:
Practice Address - Street 1:3354 INTERNATIONAL BLVD
Practice Address - Street 2:
Practice Address - City:BROWNSVILLE
Practice Address - State:TX
Practice Address - Zip Code:78521-3226
Practice Address - Country:US
Practice Address - Phone:956-548-6666
Practice Address - Fax:956-548-6667
Is Sole Proprietor?:No
Enumeration Date:2006-05-06
Last Update Date:2008-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK3668208000000X, 2080A0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
No2080A0000XAllopathic & Osteopathic PhysiciansPediatricsAdolescent Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX104844903Medicaid
TXG52029Medicare UPIN
TX104844903Medicaid