1033780721 NPI number — KARRIEM ALI MD

Table of content: KARRIEM ALI MD (NPI 1033780721)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1033780721 NPI number — KARRIEM ALI MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ALI
Provider First Name:
KARRIEM
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
ALIFFE
Provider Other First Name:
KARYEMAITRE
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
MD
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1033780721
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/12/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 1207
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
TENINO
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
98589-1207
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4315 TACOMA AVE S
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
TACOMA
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98418-6646
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
360-322-4816
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
07/05/2021

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207SG0201X , with the licence number:  MD00032373 , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 208U00000X , with the licence number: MD00032373 , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 208VP0000X , with the licence number: MD00032373 , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 261QR1100X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207LH0002X , with the licence number: MD00032373 , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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