Provider Demographics
NPI:1427099712
Name:ALI, SHEHARYAR (MD)
Entity type:Individual
Prefix:
First Name:SHEHARYAR
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 1:2205 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:RUSSELLVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72801-2759
Mailing Address - Country:US
Mailing Address - Phone:479-968-4311
Mailing Address - Fax:479-968-4399
Practice Address - Street 1:2205 W MAIN ST
Practice Address - Street 2:
Practice Address - City:RUSSELLVILLE
Practice Address - State:AR
Practice Address - Zip Code:72801-2759
Practice Address - Country:US
Practice Address - Phone:479-968-4311
Practice Address - Fax:479-968-4399
Is Sole Proprietor?:No
Enumeration Date:2006-06-09
Last Update Date:2023-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARE6059207RC0000X
IA33912207R00000X
AZ69380207RI0011X
ARE-6059207RI0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR5H762Medicare PIN