MEDICARE: MIR TARIQ 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	207RN0300X	Nephrology Physician	U7634	TX

General Provider Information

NPI Number	:	1649822040
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MIR TARIQ ALI MD

Provider Business Mailing Address
First Line	:	8431 FREDERICKSBURG RD STE 305
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78229-3392
Country	:	US
Telephone Number	:	210-450-9800
Fax Number	:	210-450-2144

Provider Business Practice Location Address
First Line	:	8431 FREDERICKSBURG RD STE 305
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78229-3392
Country	:	US
Telephone Number	:	210-450-9800
Fax Number	:	210-450-2144

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

Provider Enumeration Date	:	07/15/2019
Last Update Date	:	08/25/2025

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