Provider Demographics
NPI:1316302680
Name:ALI, FARAH III
Entity type:Individual
Prefix:
First Name:FARAH
Middle Name:
Last Name:ALI
Suffix:III
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 1:1021 E 22ND ST
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55404-2942
Mailing Address - Country:US
Mailing Address - Phone:612-245-0693
Mailing Address - Fax:
Practice Address - Street 1:1021 E 22ND STREET
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MINNESOTA
Practice Address - Zip Code:55404
Practice Address - Country:UM
Practice Address - Phone:612-245-0693
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-12-30
Last Update Date:2015-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
M913157710813343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)