Healthcare Provider Details

I. General information

NPI: 1629742887
Provider Name (Legal Business Name): AIZAZ ALI
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/02/2021
Last Update Date: 07/05/2026
Certification Date: 07/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8440 112 ST NW
EDMONTON ALBERTA
T6G 2B7
CA

IV. Provider business mailing address

APARTMENT 525 11041 86 AVENUE
EDMONTON ALBERTA
T6G 2B
CA

V. Phone/Fax

Practice location:
  • Phone:
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: