| Tareq a Ali MD APC | |
|
1520 W Kettleman Ln Ste B Lodi CA 95242-9290 | |
| (209) 339-3797 | |
| (209) 339-3795 |
| Full Name | Tareq a Ali MD APC |
|---|---|
| Speciality | Family Medicine |
| Location | 1520 W Kettleman Ln Ste B, Lodi, California |
| Authorized Official Name and Position | Tareq a Ali (PRESIDENT OF CORPORATION) |
| Authorized Official Contact | 20933393797 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Tareq a Ali MD APC 1520 W Kettleman Ln Ste B Lodi CA 95242-9290 Ph: (209) 339-3797 | Tareq a Ali MD APC 1520 W Kettleman Ln Ste B Lodi CA 95242-9290 Ph: (209) 339-3797 |
| NPI Number | 1588919716 |
|---|---|
| Provider Enumeration Date | 07/13/2012 |
| Last Update Date | 07/13/2012 |
| Medicare PECOS PAC ID | 1658520689 |
|---|---|
| Medicare Enrollment ID | O20121005000426 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1588919716 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | A51048 (California) | Primary |
| Provider Name | Tareq a Ali |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1790722718 PECOS PAC ID: 5991771172 Enrollment ID: I20040908001567 |
| Provider Name | Christian a Carter |
|---|---|
| Provider Type | Practitioner - Physician Assistant |
| Provider Identifiers | NPI Number: 1518133693 PECOS PAC ID: 6305907387 Enrollment ID: I20081209000560 |
| Provider Name | Ryan E Vaccarezza |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1982037040 PECOS PAC ID: 8224266440 Enrollment ID: I20140116000011 |
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