MEDICARE: MR. MOHAMMAD K ALI

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	261QS1200X	Sleep Disorder Diagnostic Clinic/Center

General Provider Information

NPI Number	:	1790849370
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. MOHAMMAD K ALI

Provider Business Mailing Address
First Line	:	5310 W CAPITOL DR
Second Line	:
City	:	MILWAUKEE
State	:	WI
Zip	:	53216-2263
Country	:	US
Telephone Number	:	414-442-3000
Fax Number	:	414-442-3050

Provider Business Practice Location Address
First Line	:	5310 W CAPITOL DR
Second Line	:
City	:	MILWAUKEE
State	:	WI
Zip	:	53216-2263
Country	:	US
Telephone Number	:	414-442-3000
Fax Number	:	414-442-3050

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

Provider Enumeration Date	:	12/20/2006
Last Update Date	:	07/08/2007

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