Basic Information
Provider Information
NPI: 1114119427
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: ALI
FirstName: BILAL
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential: MD
OtherOrganizationName:  
OtherOrganizationType:  
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OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: PO BOX 1000, DEPT 457
Address2:  
City: MEMPHIS
State: TN
PostalCode: 381480001
CountryCode: US
TelephoneNumber: 9012753662
FaxNumber: 9012710155
Practice Location
Address1: 1265 UNION AVE, 2 SHORB TOWER
Address2:  
City: MEMPHIS
State: TN
PostalCode: 381043415
CountryCode: US
TelephoneNumber: 9014789183
FaxNumber: 9014788957
Other Information
ProviderEnumerationDate: 08/10/2007
LastUpdateDate: 12/22/2021
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 07/20/2020

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207RT0003X54661TNY Allopathic & Osteopathic PhysiciansInternal MedicineTransplant Hepatology
207R00000X54661TNN Allopathic & Osteopathic PhysiciansInternal Medicine 
207RG0100X54661TNN Allopathic & Osteopathic PhysiciansInternal MedicineGastroenterology

No ID Information.


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