MEDICARE: ALI MOUSSAOUI M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2084N0008X	Neuromuscular Medicine (Psychiatry & Neurology) Physician	K4161	TX
2	2084N0400X	Neurology Physician	K4161	TX

General Provider Information

NPI Number	:	1114921905
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ALI MOUSSAOUI M.D.

Provider Business Mailing Address
First Line	:	PO BOX 58805
Second Line	:
City	:	WEBSTER
State	:	TX
Zip	:	77598-8805
Country	:	US
Telephone Number	:	832-290-1722
Fax Number	:	844-413-3832

Provider Business Practice Location Address
First Line	:	11914 ASTORIA BLVD
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77089-6064
Country	:	US
Telephone Number	:	832-831-1840
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/09/2005
Last Update Date	:	10/08/2024

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