Basic Information
Provider Information | |||||||||
NPI: | 1699936682 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | ALI | ||||||||
FirstName: | KARIM | ||||||||
MiddleName: | FIRDOUS | ||||||||
NamePrefix: | DR. | ||||||||
NameSuffix: |   | ||||||||
Credential: | MD | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: | ALI | ||||||||
OtherFirstName: | KARIM | ||||||||
OtherMiddleName: | F | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: | MD | ||||||||
OtherLastNameType: | 2 | ||||||||
Mailing Information | |||||||||
Address1: | 1308 N 112TH CT | ||||||||
Address2: | APT 6309 | ||||||||
City: | OMAHA | ||||||||
State: | NE | ||||||||
PostalCode: | 681545896 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 6122325546 | ||||||||
FaxNumber: |   | ||||||||
Practice Location | |||||||||
Address1: | 601 N 30TH ST | ||||||||
Address2: |   | ||||||||
City: | OMAHA | ||||||||
State: | NE | ||||||||
PostalCode: | 681312137 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 4022804180 | ||||||||
FaxNumber: |   | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 06/23/2008 | ||||||||
LastUpdateDate: | 09/08/2010 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | M | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | Y | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 390200000X |   | MN | N |   | Student, Health Care | Student in an Organized Health Care Education/Training Program |   | 390200000X |   | NE | Y |   | Student, Health Care | Student in an Organized Health Care Education/Training Program |   |
No ID Information.