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General NPI Number Information
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NPI Number | 1588919716
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Entity Type | Organization
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Legal Business Name | TAREQ A ALI MD APC
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Dates
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Enumeration Date | 07/13/2012
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Last Update Date | 07/13/2012
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Provider Practice Location Address
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Address Line | 1520 W KETTLEMAN LN STE B
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City | LODI
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State | CA
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Zip | 95242-9290
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Country | US
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Telephone | 209-339-3797
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Fax | 209-339-3795
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Provider Business Mailing Address
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Address Line | 1520 W KETTLEMAN LN STE B
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City | LODI
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State | CA
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Zip | 95242-9290
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Country | US
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Telephone | 209-339-3797
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Fax | 209-339-3795
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Authorized Official
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Title or Position | PRESIDENT OF CORPORATION
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Name | TAREQ A ALI
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Credential | MD
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Telephone | 20933393797
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | A51048
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License Number State | CA
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