Provider Demographics
NPI:1003816554
Name:ARBABI, ALI REZA (MD)
Entity type:Individual
Prefix:
First Name:ALI
Middle Name:REZA
Last Name:ARBABI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:ALIREZA
Other - Middle Name:
Other - Last Name:ARBABI
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:10409 GEORGETOWN PL
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89134-5121
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:512 SKYLINE BLVD STE 1
Practice Address - Street 2:
Practice Address - City:CLOQUET
Practice Address - State:MN
Practice Address - Zip Code:55720-1199
Practice Address - Country:US
Practice Address - Phone:218-879-4641
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-07-27
Last Update Date:2024-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN53531207Q00000X
MN105170207Q00000X
NV11538207Q00000X
ND13858207Q00000X
MNMN-53531208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV100507697Medicaid
NV100507696Medicaid
I41548Medicare UPIN
NVV101347Medicare PIN
NV101344Medicare PIN
NV100507697Medicaid
NVV101346Medicare PIN
NV101347Medicare PIN
NV101346Medicare PIN