Provider Demographics
NPI:1063479319
Name:ALBAGHDADI, ALI S (MD)
Entity Type:Individual
Prefix:DR
First Name:ALI
Middle Name:S
Last Name:ALBAGHDADI
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 1:515 22ND AVE
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:WI
Mailing Address - Zip Code:53566-1569
Mailing Address - Country:US
Mailing Address - Phone:608-324-2000
Mailing Address - Fax:563-243-0817
Practice Address - Street 1:515 22ND AVE
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:WI
Practice Address - Zip Code:53566-1569
Practice Address - Country:US
Practice Address - Phone:608-324-2000
Practice Address - Fax:563-243-0817
Is Sole Proprietor?:No
Enumeration Date:2006-04-28
Last Update Date:2018-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA36145207RC0000X
IL036-1123608207RC0000X
WI171-320207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
247143OtherMIDLANDS CHOICE
39841OtherWELLMARK BC/BS
IA0462366Medicaid
110992OtherHEALTH ALLIANCE
247143OtherMIDLANDS CHOICE
P00259160Medicare PIN
247143OtherMIDLANDS CHOICE
IAI15583Medicare PIN