Provider Demographics
NPI:1497508642
Name:MAHMOUDI, ALIREZA (MD)
Entity type:Individual
Prefix:DR
First Name:ALIREZA
Middle Name:
Last Name:MAHMOUDI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3601 W 76TH ST STE 300
Mailing Address - Street 2:
Mailing Address - City:EDINA
Mailing Address - State:MN
Mailing Address - Zip Code:55435-3004
Mailing Address - Country:US
Mailing Address - Phone:952-929-1131
Mailing Address - Fax:
Practice Address - Street 1:3601 W 76TH ST STE 300
Practice Address - Street 2:
Practice Address - City:EDINA
Practice Address - State:MN
Practice Address - Zip Code:55435-3004
Practice Address - Country:US
Practice Address - Phone:952-929-1131
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-04-08
Last Update Date:2025-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL39157207WX0107X
MN80140207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
No207WX0107XAllopathic & Osteopathic PhysiciansOphthalmologyRetina Specialist