Provider Demographics
NPI:1336163690
Name:ALI, ABBAS (MD)
Entity Type:Individual
Prefix:DR
First Name:ABBAS
Middle Name:
Last Name:ALI
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:1001 W GLEN OAKS LN STE 105
Mailing Address - Street 2:
Mailing Address - City:MEQUON
Mailing Address - State:WI
Mailing Address - Zip Code:53092-3369
Mailing Address - Country:US
Mailing Address - Phone:414-365-3210
Mailing Address - Fax:414-365-2937
Practice Address - Street 1:7733 W BURLEIGH ST
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53222-5003
Practice Address - Country:US
Practice Address - Phone:262-328-4232
Practice Address - Fax:414-562-6924
Is Sole Proprietor?:No
Enumeration Date:2006-07-27
Last Update Date:2022-11-29
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
WI42044207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI32639100Medicaid
WI73335-0014Medicare PIN
WIH14361Medicare UPIN