Healthcare Provider Details

I. General information

NPI: 1861929580
Provider Name (Legal Business Name): ALI IMRAN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/12/2017
Last Update Date: 07/27/2026
Certification Date: 07/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1130 W GROVE AVE STE 115
MESA AZ
85210-4942
US

IV. Provider business mailing address

1130 W GROVE AVE STE 115
MESA AZ
85210-4942
US

V. Phone/Fax

Practice location:
  • Phone: 480-306-5000
  • Fax: 480-452-0300
Mailing address:
  • Phone: 480-306-5000
  • Fax: 480-452-0300

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number61661
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number72994-20
License Number StateWI
# 4
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number61661
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: