Provider Demographics
NPI:1992069090
Name:ALI, MOHAMOUD (MD)
Entity type:Individual
Prefix:DR
First Name:MOHAMOUD
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 1:2112 E 117TH ST
Mailing Address - Street 2:E
Mailing Address - City:BURNSVILLE
Mailing Address - State:MN
Mailing Address - Zip Code:55337-7223
Mailing Address - Country:US
Mailing Address - Phone:612-516-8272
Mailing Address - Fax:
Practice Address - Street 1:701 PARK AVE SOUTH - MEDICINE
Practice Address - Street 2:HENNEPIN COUNTY MEDICAL CENTER
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55415-1829
Practice Address - Country:US
Practice Address - Phone:612-873-2300
Practice Address - Fax:612-904-4358
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-03
Last Update Date:2017-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY284547208M00000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine