MEDICARE: RAO K ALI MD

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	207LP2900X	Pain Medicine (Anesthesiology) Physician	35.095398	OH
2	2081P2900X	Pain Medicine (Physical Medicine & Rehabilitation) Physician	35.095398	OH
3	2081P2900X	Pain Medicine (Physical Medicine & Rehabilitation) Physician	R2266	TX

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	654741	OTHER		MEDICARE PTAN

General Provider Information

NPI Number	:	1558694539
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RAO K ALI MD

Provider Business Mailing Address
First Line	:	1609 ENCLAVE CT
Second Line	:
City	:	SOUTHLAKE
State	:	TX
Zip	:	76092-3461
Country	:	US
Telephone Number	:	732-610-6120
Fax Number	:

Provider Business Practice Location Address
First Line	:	405 W CAMPBELL RD
Second Line	:	SUITE 305
City	:	RICHARDSON
State	:	TX
Zip	:	75080-3468
Country	:	US
Telephone Number	:	469-562-4188
Fax Number	:	469-562-4166

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

Provider Enumeration Date	:	09/09/2009
Last Update Date	:	06/17/2022

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Directions to “ RAO K ALI MD” Practice Location

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