Provider Demographics
NPI:1962513168
Name:HAAS, ALI EKREM (MD)
Entity type:Individual
Prefix:DR
First Name:ALI
Middle Name:EKREM
Last Name:HAAS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:836 SUNSET LAKE BLVD STE 103
Mailing Address - Street 2:
Mailing Address - City:VENICE
Mailing Address - State:FL
Mailing Address - Zip Code:34292-7555
Mailing Address - Country:US
Mailing Address - Phone:941-492-4775
Mailing Address - Fax:941-492-6650
Practice Address - Street 1:836 SUNSET LAKE BLVD STE 103
Practice Address - Street 2:
Practice Address - City:VENICE
Practice Address - State:FL
Practice Address - Zip Code:34292-7555
Practice Address - Country:US
Practice Address - Phone:941-492-4775
Practice Address - Fax:941-492-6650
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-31
Last Update Date:2008-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME 0054306208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLE 60245Medicare UPIN
FL08287Medicare ID - Type Unspecified