Healthcare Provider Details

I. General information

NPI: 1134547482
Provider Name (Legal Business Name): ALI MEDICAL CENTER INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/03/2014
Last Update Date: 04/03/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2105 PALM BAY RD NE SUITE # 1
PALM BAY FL
32905-2937
US

IV. Provider business mailing address

2105 PALM BAY RD NE SUITE 1
PALM BAY FL
32905-2937
US

V. Phone/Fax

Practice location:
  • Phone: 321-676-1230
  • Fax:
Mailing address:
  • Phone: 321-676-1230
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number62108
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number44893
License Number StateFL

VIII. Authorized Official

Name: SABIR ALI
Title or Position: PRESIDENT
Credential: MD
Phone: 321-676-1230