Provider Demographics
NPI:1790753721
Name:MOSTOUFI, SEYED ALI (MD)
Entity type:Individual
Prefix:DR
First Name:SEYED
Middle Name:ALI
Last Name:MOSTOUFI
Suffix:
Gender:
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1611 NW 12TH AVE
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33136-1005
Mailing Address - Country:US
Mailing Address - Phone:617-201-7721
Mailing Address - Fax:305-243-4650
Practice Address - Street 1:1295 NW 14TH ST
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33125-1610
Practice Address - Country:US
Practice Address - Phone:305-243-3658
Practice Address - Fax:305-243-4650
Is Sole Proprietor?:No
Enumeration Date:2006-03-08
Last Update Date:2025-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2125422081P2900X
FLME1720752081P2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2081P2900XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationPain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA466505OtherTUFTS HEALTH PLAN
MA2034221Medicaid
MAJ27131OtherBCBSMA
MA466505OtherTUFTS HEALTH PLAN
MAJ27131OtherBCBSMA