Provider Demographics
NPI:1952374464
Name:MADANI, ALI ALAIN (MD, PHD)
Entity Type:Individual
Prefix:DR
First Name:ALI
Middle Name:ALAIN
Last Name:MADANI
Suffix:
Gender:M
Credentials:MD, PHD
Other - Prefix:DR
Other - First Name:ALI
Other - Middle Name:
Other - Last Name:MADANI
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD, PHD
Mailing Address - Street 1:1760 E RIVER RD
Mailing Address - Street 2:STE 350
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85718-5877
Mailing Address - Country:US
Mailing Address - Phone:520-519-7720
Mailing Address - Fax:520-519-5181
Practice Address - Street 1:209 MARTIN LUTHER KING JR WAY
Practice Address - Street 2:
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98405-4265
Practice Address - Country:US
Practice Address - Phone:253-596-3300
Practice Address - Fax:253-596-3301
Is Sole Proprietor?:No
Enumeration Date:2006-02-07
Last Update Date:2022-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301070143207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ076877Medicaid
AZ860938204OtherTAX ID
AZZ110368Medicare PIN
AZ076877Medicaid