Individual
MARYYAM ALI
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
1997 SLOAN PL STE 17, MAPLEWOOD, MN 55117
(651) 772-6251
(651) 224-9661
Mailing address
2854 HIGHWAY 55 STE 130, EAGAN, MN 55121-1447
(651) 842-3349
(651) 842-3391
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
MT205639
PA
207RN0300X
Nephrology Physician
Primary
62073
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1518386093
NPI
—
01
—
62073
MN MEDICAL LICENSE
MN
Enumeration date
04/10/2014
Last updated
10/08/2019
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