Healthcare Provider Details

I. General information

NPI: 1790753721
Provider Name (Legal Business Name): SEYED ALI MOSTOUFI M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/08/2006
Last Update Date: 08/26/2025
Certification Date: 08/26/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1295 NW 14TH ST
MIAMI FL
33125-1610
US

IV. Provider business mailing address

1611 NW 12TH AVE
MIAMI FL
33136-1005
US

V. Phone/Fax

Practice location:
  • Phone: 305-243-3658
  • Fax: 305-243-4650
Mailing address:
  • Phone: 617-201-7721
  • Fax: 305-243-4650

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2081P2900X
TaxonomyPain Medicine (Physical Medicine & Rehabilitation) Physician
License NumberME172075
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License NumberME172075
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: