MEDICARE: ALI IMRAN M.D.

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	208M00000X	Hospitalist Physician	61661	AZ
2	390200000X	Student in an Organized Health Care Education/Training Program
3	207R00000X	Internal Medicine Physician	61661	AZ
4	207R00000X	Internal Medicine Physician	72994-20	WI

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	:	1861929580
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ALI IMRAN M.D.

Provider Business Mailing Address
First Line	:	1130 W GROVE AVE STE 115
Second Line	:
City	:	MESA
State	:	AZ
Zip	:	85210-4942
Country	:	US
Telephone Number	:	480-306-5000
Fax Number	:	480-452-0300

Provider Business Practice Location Address
First Line	:	1130 W GROVE AVE STE 115
Second Line	:
City	:	MESA
State	:	AZ
Zip	:	85210-4942
Country	:	US
Telephone Number	:	480-306-5000
Fax Number	:	480-452-0300

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

Provider Enumeration Date	:	05/12/2017
Last Update Date	:	09/12/2024

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Directions to “ ALI IMRAN M.D.” Practice Location

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