Provider Demographics
NPI:1891203287
Name:ALI, ISMAIL IBRAHIM
Entity Type:Individual
Prefix:MR
First Name:ISMAIL
Middle Name:IBRAHIM
Last Name:ALI
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3601 E MCDOWELL RD
Mailing Address - Street 2:APT 1020
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85008
Mailing Address - Country:US
Mailing Address - Phone:602-459-5215
Mailing Address - Fax:
Practice Address - Street 1:3601 E MCDOWELL RD APT 1020
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85008-4378
Practice Address - Country:US
Practice Address - Phone:602-459-5215
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-01-19
Last Update Date:2018-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)