Basic Information
| Provider Information | |||||||||
| NPI: | 1821047218 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | ALI | ||||||||
| FirstName: | ASIM | ||||||||
| MiddleName: | M | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3009 N BALLAS RD | ||||||||
| Address2: | STE 100B | ||||||||
| City: | SAINT LOUIS | ||||||||
| State: | MO | ||||||||
| PostalCode: | 631312322 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3144321111 | ||||||||
| FaxNumber: | 3144326308 | ||||||||
| Practice Location | |||||||||
| Address1: | 3009 N BALLAS RD | ||||||||
| Address2: | STE 100B | ||||||||
| City: | SAINT LOUIS | ||||||||
| State: | MO | ||||||||
| PostalCode: | 631312322 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3144321111 | ||||||||
| FaxNumber: | 3144326308 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/10/2006 | ||||||||
| LastUpdateDate: | 01/08/2014 | ||||||||
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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 | 207R00000X | 2003014724 | MO | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
ID Information
| ID | Type | State | Issuer | Description | 1821047218 | 01 | MO | NPI | OTHER | 036115806 | 01 | IL | BCBS IL | OTHER | P00274736 | 01 | MO | RR MEDICARE | OTHER | R01060 | 01 | IL | MEDICARE | OTHER | 1821047218 | 05 | MO | MEDICAID |