Provider Demographics
NPI:1194051474
Name:ALI, IHAB M (DPT)
Entity type:Individual
Prefix:
First Name:IHAB
Middle Name:M
Last Name:ALI
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12002 HARDWICK DR
Mailing Address - Street 2:
Mailing Address - City:FISHERS
Mailing Address - State:IN
Mailing Address - Zip Code:46038-1363
Mailing Address - Country:US
Mailing Address - Phone:317-640-3769
Mailing Address - Fax:
Practice Address - Street 1:12002 HARDWICK DR
Practice Address - Street 2:
Practice Address - City:FISHERS
Practice Address - State:IN
Practice Address - Zip Code:46038-1363
Practice Address - Country:US
Practice Address - Phone:317-640-3769
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-10-21
Last Update Date:2009-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN05005560A251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health