Provider Demographics
NPI:1851612592
Name:ALI, MUJTABA MOHAMMED (MD)
Entity type:Individual
Prefix:
First Name:MUJTABA
Middle Name:MOHAMMED
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 1:5323 HARRY HINES BLVD
Mailing Address - Street 2:MC 9157
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75390-9157
Mailing Address - Country:US
Mailing Address - Phone:214-645-0545
Mailing Address - Fax:
Practice Address - Street 1:5323 HARRY HINES BLVD
Practice Address - Street 2:MC 9157
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75390-9157
Practice Address - Country:US
Practice Address - Phone:214-645-0545
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-06-17
Last Update Date:2023-04-14
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MA2455212086S0129X
TXQ53262086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery