Provider Demographics
NPI:1851546121
Name:ALI, SLAMAT (MD)
Entity Type:Individual
Prefix:
First Name:SLAMAT
Middle Name:
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 1:568 E HERNDON AVE STE 201
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93720-2989
Mailing Address - Country:US
Mailing Address - Phone:559-558-8671
Mailing Address - Fax:661-527-9002
Practice Address - Street 1:3933 COFFEE RD STE B
Practice Address - Street 2:
Practice Address - City:BAKERSFIELD
Practice Address - State:CA
Practice Address - Zip Code:93308-5024
Practice Address - Country:US
Practice Address - Phone:559-228-6600
Practice Address - Fax:559-226-3709
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-29
Last Update Date:2021-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC145592207R00000X, 207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC5920689Medicaid
NCNC7544AMedicare PIN
NCNC7544CMedicare PIN
NC1851546121Medicaid
SCNC1639Medicaid
NCNC7544BMedicare PIN