MEDICARE: MUHAMMAD M. ALI MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2084P0804X	Child & Adolescent Psychiatry Physician	036112644	IL
2	2084P0804X	Child & Adolescent Psychiatry Physician	04-30218	KS
3	2084P0800X	Psychiatry Physician	04-30218	KS

General Provider Information

NPI Number	:	1073537130
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MUHAMMAD M. ALI MD

Provider Business Mailing Address
First Line	:	1427 N GLEN WOOD CT
Second Line	:
City	:	WICHITA
State	:	KS
Zip	:	67230-1708
Country	:	US
Telephone Number	:	316-613-1078
Fax Number	:	316-854-0809

Provider Business Practice Location Address
First Line	:	1427 N GLEN WOOD CT
Second Line	:
City	:	WICHITA
State	:	KS
Zip	:	67230-1708
Country	:	US
Telephone Number	:	316-613-1078
Fax Number	:	316-854-0809

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/26/2006
Last Update Date	:	04/23/2009

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