Basic Information
| Provider Information | |||||||||
| NPI: | 1700048147 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | ALI | ||||||||
| FirstName: | AHMAD | ||||||||
| MiddleName: | HASSAN | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 843966 | ||||||||
| Address2: | |||||||||
| City: | KANSAS CITY | ||||||||
| State: | MO | ||||||||
| PostalCode: | 641843966 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5738843300 | ||||||||
| FaxNumber: | 5738840943 | ||||||||
| Practice Location | |||||||||
| Address1: | 101 S FAIRVIEW RD | ||||||||
| Address2: | |||||||||
| City: | COLUMBIA | ||||||||
| State: | MO | ||||||||
| PostalCode: | 652037637 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5738847600 | ||||||||
| FaxNumber: | 5738848200 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/26/2008 | ||||||||
| LastUpdateDate: | 08/15/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 06/23/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 43588 | TX | N | Allopathic & Osteopathic Physicians | Internal Medicine | 207R00000X | 43998 | TX | N | Allopathic & Osteopathic Physicians | Internal Medicine | 390200000X | BP1-0031774 | TX | N | Student, Health Care | Student in an Organized Health Care Education/Training Program | 207RI0008X | 2021029589 | MO | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Hepatology |
ID Information
| ID | Type | State | Issuer | Description | 87772256 | 05 | NM | MEDICAID | 285984501 | 05 | TX | MEDICAID | 200056477 | 05 | MO | MEDICAID | 200388520 A | 05 | OK | MEDICAID |