Provider Demographics
NPI:1457624082
Name:KASHIF R. ALI,MD,PA
Entity Type:Organization
Organization Name:KASHIF R. ALI,MD,PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:KASHIF
Authorized Official - Middle Name:R
Authorized Official - Last Name:ALI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:678-471-9592
Mailing Address - Street 1:15810 LONG NECK DR
Mailing Address - Street 2:
Mailing Address - City:MAGNOLIA
Mailing Address - State:TX
Mailing Address - Zip Code:77355-3655
Mailing Address - Country:US
Mailing Address - Phone:832-277-1178
Mailing Address - Fax:
Practice Address - Street 1:10900 JONES RD
Practice Address - Street 2:SUITE 1
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77065-5471
Practice Address - Country:US
Practice Address - Phone:678-471-9592
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-02-13
Last Update Date:2016-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL2089208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0039XQOtherBLUE CROSS BLUE SHIELD
TX2886137Medicaid
TX0039XQOtherBLUE CROSS BLUE SHIELD