Provider Demographics
NPI:1154521540
Name:ALI, SHAUKAT (MD)
Entity type:Individual
Prefix:
First Name:SHAUKAT
Middle Name:
Last Name:ALI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1313 E HERNDON AVE
Mailing Address - Street 2:SUITE 203
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93720-3306
Mailing Address - Country:US
Mailing Address - Phone:559-439-6808
Mailing Address - Fax:559-439-9335
Practice Address - Street 1:1313 E HERNDON AVE
Practice Address - Street 2:SUITE 203
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93720-3306
Practice Address - Country:US
Practice Address - Phone:559-439-6808
Practice Address - Fax:559-439-9335
Is Sole Proprietor?:No
Enumeration Date:2007-07-23
Last Update Date:2017-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA100025207RC0000X, 207RI0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA0A1000250Medicaid
CAA100025OtherCALIFORNIA MEDICAL LICENS
CA00A1000250Medicare PIN
CA00A1000251Medicare PIN