Provider Demographics
NPI:1386612448
Name:ALI, MOHAMMED Y (MD)
Entity type:Individual
Prefix:DR
First Name:MOHAMMED
Middle Name:Y
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 1:342 E 109TH AVE
Mailing Address - Street 2:
Mailing Address - City:CROWN POINT
Mailing Address - State:IN
Mailing Address - Zip Code:46307-8693
Mailing Address - Country:US
Mailing Address - Phone:219-310-2550
Mailing Address - Fax:
Practice Address - Street 1:1630 45TH AVE
Practice Address - Street 2:
Practice Address - City:MUNSTER
Practice Address - State:IN
Practice Address - Zip Code:46321-3963
Practice Address - Country:US
Practice Address - Phone:219-924-3252
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-03-14
Last Update Date:2012-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01029782207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN100318960Medicaid
IN5171410002OtherDMERC
F12700Medicare UPIN
IN100318960Medicaid