Provider Demographics
NPI:1962668574
Name:ALI, MOHAMMED ABBAS (MD,)
Entity Type:Individual
Prefix:DR
First Name:MOHAMMED
Middle Name:ABBAS
Last Name:ALI
Suffix:
Gender:M
Credentials:MD,
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:16594 N DALE MABRY HWY
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33618-1325
Mailing Address - Country:US
Mailing Address - Phone:813-933-1944
Mailing Address - Fax:813-933-4332
Practice Address - Street 1:16594 N DALE MABRY HWY
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33618-1325
Practice Address - Country:US
Practice Address - Phone:813-933-1944
Practice Address - Fax:813-933-4332
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-03
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35096252207RR0500X
OH35-096252207R00000X
390200000X
FLME127983207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatology
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training ProgramGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH3102289Medicaid
FL692394Medicaid
OHP00888397Medicare PIN
OHAL4305391Medicare PIN