Provider Demographics
NPI:1568130847
Name:ALI, MOHAMMAD OUSSAMA (MD)
Entity type:Individual
Prefix:
First Name:MOHAMMAD
Middle Name:OUSSAMA
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 1:4915 S 202ND AVE APT 2
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68135-3930
Mailing Address - Country:US
Mailing Address - Phone:605-214-1656
Mailing Address - Fax:
Practice Address - Street 1:4350 DEWEY AVE
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68105-1017
Practice Address - Country:US
Practice Address - Phone:402-552-2000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-09-01
Last Update Date:2024-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE36266390200000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program