Basic Information
| Provider Information | |||||||||
| NPI: | 1376872879 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | ALI INTERNAL MEDICINE ASSOCIATES, PC | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 3480 | ||||||||
| Address2: | |||||||||
| City: | JOPLIN | ||||||||
| State: | MO | ||||||||
| PostalCode: | 648033480 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4176248730 | ||||||||
| FaxNumber: | 4176248745 | ||||||||
| Practice Location | |||||||||
| Address1: | 2216 E 32ND ST STE 101 | ||||||||
| Address2: | |||||||||
| City: | JOPLIN | ||||||||
| State: | MO | ||||||||
| PostalCode: | 648043015 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4176248730 | ||||||||
| FaxNumber: | 4176248745 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/11/2009 | ||||||||
| LastUpdateDate: | 11/10/2010 | ||||||||
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| AuthorizedOfficialLastName: | ALI | ||||||||
| AuthorizedOfficialFirstName: | IFTIKHAR | ||||||||
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| AuthorizedOfficialTitleorPosition: | PHYSICIAN | ||||||||
| AuthorizedOfficialTelephone: | 4176248730 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine |
ID Information
| ID | Type | State | Issuer | Description | 205269418 | 05 | MO | MEDICAID |