Provider Demographics
NPI:1285607135
Name:ALI, MOHAMED AS (MD)
Entity type:Individual
Prefix:
First Name:MOHAMED
Middle Name:AS
Last Name:ALI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:MOHAMED
Other - Middle Name:A SAID
Other - Last Name:ALI
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:670 MASON RIDGE CENTER DR
Mailing Address - Street 2:STE. 300
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63141-8573
Mailing Address - Country:US
Mailing Address - Phone:314-355-5300
Mailing Address - Fax:314-521-4656
Practice Address - Street 1:1225 GRAHAM RD STE C-2320
Practice Address - Street 2:
Practice Address - City:FLORISSANT
Practice Address - State:MO
Practice Address - Zip Code:63031-8030
Practice Address - Country:US
Practice Address - Phone:314-953-6801
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-02-10
Last Update Date:2025-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2005004127207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO207393000Medicaid
MOI38789Medicare UPIN