Basic Information
| Provider Information | |||||||||
| NPI: | 1730413592 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | ALI M CARINE, DO, LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3300 RIVERSIDE DRIVE | ||||||||
| Address2: | SUITE 200 | ||||||||
| City: | COLUMBUS | ||||||||
| State: | OH | ||||||||
| PostalCode: | 43221 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6142762400 | ||||||||
| FaxNumber: | 6142762500 | ||||||||
| Practice Location | |||||||||
| Address1: | 3300 RIVERSIDE DR | ||||||||
| Address2: | SUITE 200 | ||||||||
| City: | UPPER ARLINGTON | ||||||||
| State: | OH | ||||||||
| PostalCode: | 432211738 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6142762400 | ||||||||
| FaxNumber: | 6142762500 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/28/2009 | ||||||||
| LastUpdateDate: | 09/28/2009 | ||||||||
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| AuthorizedOfficialLastName: | CARINE | ||||||||
| AuthorizedOfficialFirstName: | ALI | ||||||||
| AuthorizedOfficialMiddleName: | M | ||||||||
| AuthorizedOfficialTitleorPosition: | OWNER/PHYSICIAN | ||||||||
| AuthorizedOfficialTelephone: | 6142762400 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | DO | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 174400000X | 34-007311 | OH | Y | 193400000X SINGLE SPECIALTY GROUP | Other Service Providers | Specialist |
ID Information
| ID | Type | State | Issuer | Description | 2298375 | 05 | OH | MEDICAID |