Provider Demographics
NPI:1851587257
Name:AKKIL ALI MD PA
Entity Type:Organization
Organization Name:AKKIL ALI MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:AKKIL
Authorized Official - Middle Name:
Authorized Official - Last Name:ALI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:954-721-6541
Mailing Address - Street 1:7710 NW 71ST CT
Mailing Address - Street 2:SUITE 304
Mailing Address - City:TAMARAC
Mailing Address - State:FL
Mailing Address - Zip Code:33321-2973
Mailing Address - Country:US
Mailing Address - Phone:954-721-6541
Mailing Address - Fax:954-721-6579
Practice Address - Street 1:7710 NW 71ST CT
Practice Address - Street 2:SUITE 304
Practice Address - City:TAMARAC
Practice Address - State:FL
Practice Address - Zip Code:33321-2973
Practice Address - Country:US
Practice Address - Phone:954-721-6541
Practice Address - Fax:954-721-6579
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:AKKIL ALI MDPA
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-09-19
Last Update Date:2007-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME87638207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLI05332Medicare UPIN