Provider Demographics
NPI:1831509595
Name:ALI-MUCHERU, MARIAM N (MD)
Entity type:Individual
Prefix:
First Name:MARIAM
Middle Name:N
Last Name:ALI-MUCHERU
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:980 JOHNSON FY RD NE
Mailing Address - Street 2:STE 880
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30342-1609
Mailing Address - Country:US
Mailing Address - Phone:404-255-8304
Mailing Address - Fax:
Practice Address - Street 1:16818 N 56TH ST
Practice Address - Street 2:
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85254-1215
Practice Address - Country:US
Practice Address - Phone:000-000-0000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-05-04
Last Update Date:2021-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI73067-20208600000X
GA88221208600000X
AZ51148208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery