Provider Demographics
NPI:1811103831
Name:MURAD, ALI K (MD)
Entity type:Individual
Prefix:
First Name:ALI
Middle Name:K
Last Name:MURAD
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1600 NORTH GRAND AVE
Mailing Address - Street 2:SUITE 508
Mailing Address - City:PUEBLO
Mailing Address - State:CO
Mailing Address - Zip Code:81003-2757
Mailing Address - Country:US
Mailing Address - Phone:719-595-7040
Mailing Address - Fax:719-595-7045
Practice Address - Street 1:1600 NORTH GRAND AVE
Practice Address - Street 2:SUITE 508
Practice Address - City:PUEBLO
Practice Address - State:CO
Practice Address - Zip Code:81003-2757
Practice Address - Country:US
Practice Address - Phone:719-595-7040
Practice Address - Fax:719-595-7045
Is Sole Proprietor?:No
Enumeration Date:2007-05-15
Last Update Date:2012-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA97510207T00000X
CO49958207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO22731555Medicaid
COP00997273OtherRR MEDICARE