Provider Demographics
NPI:1760281216
Name:AL ALI, IBRAHIM AHMED
Entity type:Individual
Prefix:
First Name:IBRAHIM
Middle Name:AHMED
Last Name:AL ALI
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1218 ELLETA BLVD
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:MO
Mailing Address - Zip Code:65202-1856
Mailing Address - Country:US
Mailing Address - Phone:573-356-4982
Mailing Address - Fax:
Practice Address - Street 1:1218 ELLETA BLVD
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:MO
Practice Address - Zip Code:65202-1856
Practice Address - Country:US
Practice Address - Phone:573-356-4982
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-03-10
Last Update Date:2025-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO172A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172A00000XOther Service ProvidersDriver