Provider Demographics
NPI:1003062555
Name:ALI-NAZIMUDDIN, ALIYA NARGIS (DO)
Entity Type:Individual
Prefix:
First Name:ALIYA
Middle Name:NARGIS
Last Name:ALI-NAZIMUDDIN
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:ALIA
Other - Middle Name:NARGIS
Other - Last Name:ALI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DO
Mailing Address - Street 1:1044 KUFRIN WAY
Mailing Address - Street 2:
Mailing Address - City:LOMBARD
Mailing Address - State:IL
Mailing Address - Zip Code:60148-3429
Mailing Address - Country:US
Mailing Address - Phone:630-915-0517
Mailing Address - Fax:
Practice Address - Street 1:121 S WILKE RD
Practice Address - Street 2:
Practice Address - City:ARLINGTON HEIGHTS
Practice Address - State:IL
Practice Address - Zip Code:60005-1533
Practice Address - Country:US
Practice Address - Phone:847-686-3456
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-08-15
Last Update Date:2013-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036.1274092084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry