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General NPI Number Information
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NPI Number | 1861748345
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Entity Type | Individual
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Provider Name | FAHAD ALI MD
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Gender | Male
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Dates
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Enumeration Date | 08/02/2012
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Last Update Date | 08/18/2023
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Provider Practice Location Address
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Address Line | 2000 HARTMAN RD STE 1
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City | FORT PIERCE
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State | FL
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Zip | 34947-4413
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Country | US
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Telephone | 772-402-3449
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Fax | 772-310-3811
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Provider Business Mailing Address
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Address Line | 2609 S FEDERAL HWY # 1049
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City | FORT PIERCE
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State | FL
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Zip | 34982-5923
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Country | US
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Telephone | 570-867-3025
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Fax | 772-310-3811
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RC0001X
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Taxonomy Name | Clinical Cardiac Electrophysiology Physician
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License Number | ME145931
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 207RC0000X
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Taxonomy Name | Cardiovascular Disease Physician
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License Number | ME145931
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License Number State | FL
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