Provider Demographics
NPI:1124654744
Name:ALI, ABDINAASIR M SR
Entity type:Individual
Prefix:
First Name:ABDINAASIR
Middle Name:M
Last Name:ALI
Suffix:SR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5151 S HOWELL AVE STE H
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53207-6179
Mailing Address - Country:US
Mailing Address - Phone:414-813-1800
Mailing Address - Fax:
Practice Address - Street 1:5151 S HOWELL AVE STE H
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53207-6179
Practice Address - Country:US
Practice Address - Phone:414-813-1800
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-03-15
Last Update Date:2020-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WIA400013715205172A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes172A00000XOther Service ProvidersDriverGroup - Single Specialty