MEDICARE: ALI MOKHTARI, MD, INC.

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	208600000X	Surgery Physician	35035614	OH

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1659403426
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ALI MOKHTARI, MD, INC.

Provider Business Mailing Address
First Line	:	3121 W BROAD ST
Second Line	:
City	:	COLUMBUS
State	:	OH
Zip	:	43204-1306
Country	:	US
Telephone Number	:	614-351-0450
Fax Number	:	614-351-1125

Provider Business Practice Location Address
First Line	:	3121 W BROAD ST
Second Line	:
City	:	COLUMBUS
State	:	OH
Zip	:	43204-1306
Country	:	US
Telephone Number	:	614-351-0450
Fax Number	:	614-351-1125

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. ALI MOKHTARI
Credential	:	M.D.
Telephone Number	:	614-351-0450

Provider Enumeration Date	:	03/09/2007
Last Update Date	:	06/13/2008

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