Provider Demographics
NPI:1295759694
Name:ALI, MIR BASHARAT (MD)
Entity type:Individual
Prefix:
First Name:MIR
Middle Name:BASHARAT
Last Name:ALI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:101 E BEVERLY BLVD STE 408
Mailing Address - Street 2:
Mailing Address - City:MONTEBELLO
Mailing Address - State:CA
Mailing Address - Zip Code:90640-4317
Mailing Address - Country:US
Mailing Address - Phone:323-726-9606
Mailing Address - Fax:323-727-1036
Practice Address - Street 1:101 E BEVERLY BLVD STE 408
Practice Address - Street 2:
Practice Address - City:MONTEBELLO
Practice Address - State:CA
Practice Address - Zip Code:90640-4317
Practice Address - Country:US
Practice Address - Phone:237-269-6063
Practice Address - Fax:323-726-9609
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-27
Last Update Date:2019-10-17
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CAA43033207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
1295759694OtherBLUE CROSS BLUE SHIELD
CAE71382Medicare UPIN