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Individual

DR. MIR I ALI

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
MD

Contact information

Practice address
8075 N SHADELAND AVE, STE 200, INDIANAPOLIS, IN 46250-2693
(317) 621-8640
Mailing address
6626 E 75TH ST, SUITE 500, INDIANAPOLIS, IN 46250-2890

Taxonomy

Speciality
Code
Description
License number
State
207RC0000X
Cardiovascular Disease Physician
0101239608
VA
207RC0000X
Cardiovascular Disease Physician
01063192A
IN
207RI0011X
Interventional Cardiology Physician
Primary
01063192A
IN

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
010273331
VA
01
196861
ANTHEM BCBS
VA
05
200858830A
IN
01
2147652
MAMSI
VA
05
5903821
NC
01
P00387869
MEDICARE RAILROAD
IN
01
P01512396
MEDICARE RAILROAD PTAN
IN
Enumeration date
06/29/2006
Last updated
02/06/2024
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