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NPI Code Detail

MEDICARE: ALI EJAZ MD

MEDICARE: ALI EJAZ 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
1207R00000XInternal Medicine Physician01098247AIN

General Provider Information

NPI Number : 1730969056
Entity Type Code : Individual
Provider Name (Legal Business Name) : ALI EJAZ MD
Provider Business Mailing Address
First Line : 1100 REID PKWY
Second Line : REID HEALTH PAYOR ENROLLMENT
City : RICHMOND
State : IN
Zip : 47374-1157
Country : US
Telephone Number : 765-983-3000
Fax Number : 765-935-8592
Provider Business Practice Location Address
First Line : 401 S MAIN ST STE 241
Second Line :
City : AKRON
State : OH
Zip : 44311-1118
Country : US
Telephone Number : 313-358-4381
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/03/2023
Last Update Date : 06/01/2026

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