Basic Information
| Provider Information | |||||||||
| NPI: | 1194993105 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | ALI | ||||||||
| FirstName: | FAHD | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 601 E ROLLINS ST | ||||||||
| Address2: | |||||||||
| City: | ORLANDO | ||||||||
| State: | FL | ||||||||
| PostalCode: | 328031248 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4073037283 | ||||||||
| FaxNumber: | 4073030347 | ||||||||
| Practice Location | |||||||||
| Address1: | 601 E ROLLINS ST | ||||||||
| Address2: | |||||||||
| City: | ORLANDO | ||||||||
| State: | FL | ||||||||
| PostalCode: | 328031248 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4073037283 | ||||||||
| FaxNumber: | 4073030347 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/12/2008 | ||||||||
| LastUpdateDate: | 08/08/2019 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208600000X | 244248 | NY | N | Allopathic & Osteopathic Physicians | Surgery | 2086S0102X | 244248 | NY | N | Allopathic & Osteopathic Physicians | Surgery | Surgical Critical Care | 2086S0127X | 244248 | NY | N | Allopathic & Osteopathic Physicians | Surgery | Trauma Surgery | 2086S0102X | ME140937 | FL | Y | Allopathic & Osteopathic Physicians | Surgery | Surgical Critical Care |
ID Information
| ID | Type | State | Issuer | Description | 03017163 | 05 | NY | MEDICAID | P00636829 | 01 | NY | RAILROAD MEDICARE | OTHER |