MEDICARE: MIR M ALI M D A PROFESSIONAL CORPORATION

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	207R00000X	Internal Medicine Physician

General Provider Information

NPI Number	:	1568574994
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MIR M ALI M D A PROFESSIONAL CORPORATION

Provider Business Mailing Address
First Line	:	3400 W BALL RD STE 205
Second Line	:
City	:	ANAHEIM
State	:	CA
Zip	:	92804-3737
Country	:	US
Telephone Number	:	714-828-2554
Fax Number	:

Provider Business Practice Location Address
First Line	:	3400 W BALL RD STE 205
Second Line	:
City	:	ANAHEIM
State	:	CA
Zip	:	92804-3737
Country	:	US
Telephone Number	:	714-828-2554
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. MIR M ALI
Credential	:	MD
Telephone Number	:	714-828-2554

Provider Enumeration Date	:	08/31/2006
Last Update Date	:	01/15/2015

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