Individual
DR. ALI A DIBA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
3201 S 16TH ST, 2015, MILWAUKEE, WI 53215-4537
(414) 908-6500
(414) 385-2980
Mailing address
3033 S 27TH ST, SUITE 202, MILWAUKEE, WI 53215-3600
(414) 908-6601
(414) 385-2980
Taxonomy
Speciality
Code
Description
License number
State
207RG0100X
Gastroenterology Physician
Primary
20383-020
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
30902300
—
WI
Enumeration date
03/28/2006
Last updated
07/08/2007
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