Provider Demographics
NPI:1982058020
Name:ALI, WALID MOHAMMED
Entity Type:Individual
Prefix:
First Name:WALID
Middle Name:MOHAMMED
Last Name:ALI
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6030 ABBEY CHAPEL DR
Mailing Address - Street 2:
Mailing Address - City:DUBLIN
Mailing Address - State:OH
Mailing Address - Zip Code:43017-3517
Mailing Address - Country:US
Mailing Address - Phone:614-424-1496
Mailing Address - Fax:
Practice Address - Street 1:6030 ABBEY CHAPEL DR
Practice Address - Street 2:
Practice Address - City:DUBLIN
Practice Address - State:OH
Practice Address - Zip Code:43017-3517
Practice Address - Country:US
Practice Address - Phone:614-424-1496
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-04-14
Last Update Date:2016-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHHIC-L00299171WH0202X
OHG02501171WH0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171WH0202XOther Service ProvidersContractorHome Modifications
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0158376Medicaid