Healthcare Provider Details

I. General information

NPI: 1356961593
Provider Name (Legal Business Name): ALI MERHE MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/17/2020
Last Update Date: 07/15/2022
Certification Date: 07/15/2022
Deactivation Date: 01/10/2022
Reactivation Date: 04/28/2022

III. Provider practice location address

1611 NW 12 AVENUE
MIAMI FL
33136
US

IV. Provider business mailing address

3904 SUN WAY
MORGANTOWN WV
26505-1148
US

V. Phone/Fax

Practice location:
  • Phone: 305-243-3670
  • Fax:
Mailing address:
  • Phone: 305-898-9692
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code208800000X
TaxonomyUrology Physician
License Number31588
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: