Basic Information
Provider Information | |||||||||
NPI: | 1568647006 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | SAAD | ||||||||
FirstName: | ALI | ||||||||
MiddleName: | G | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: | MD | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | 1475 NW 12TH AVE STE 2125 | ||||||||
Address2: |   | ||||||||
City: | MIAMI | ||||||||
State: | FL | ||||||||
PostalCode: | 331361002 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 3052431111 | ||||||||
FaxNumber: |   | ||||||||
Practice Location | |||||||||
Address1: | 1475 NW 12TH AVE STE 2125 | ||||||||
Address2: |   | ||||||||
City: | MIAMI | ||||||||
State: | FL | ||||||||
PostalCode: | 331361002 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 3052431111 | ||||||||
FaxNumber: |   | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 01/03/2008 | ||||||||
LastUpdateDate: | 08/19/2019 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | M | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207ZN0500X | 24260 | MS | N |   | Allopathic & Osteopathic Physicians | Pathology | Neuropathology | 207ZN0500X | 57054 | TN | N |   | Allopathic & Osteopathic Physicians | Pathology | Neuropathology | 207ZP0213X | 24260 | MS | N |   | Allopathic & Osteopathic Physicians | Pathology | Pediatric Pathology | 207ZP0213X | 57054 | TN | N |   | Allopathic & Osteopathic Physicians | Pathology | Pediatric Pathology | 207ZP0102X | ME124512 | FL | Y |   | Allopathic & Osteopathic Physicians | Pathology | Anatomic Pathology & Clinical Pathology |
ID Information
ID | Type | State | Issuer | Description | 00620209 | 05 | MS |   | MEDICAID | 169934001 | 05 | AR |   | MEDICAID |