Provider Demographics
NPI:1073563581
Name:BAWAMIA, ALI H (MD)
Entity Type:Individual
Prefix:DR
First Name:ALI
Middle Name:H
Last Name:BAWAMIA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1000 REMINGTON BLVD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:BOLINGBROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60440-5114
Mailing Address - Country:US
Mailing Address - Phone:630-312-7755
Mailing Address - Fax:630-856-9933
Practice Address - Street 1:1000 REMINGTON BLVD
Practice Address - Street 2:SUITE 200
Practice Address - City:BOLINGBROOK
Practice Address - State:IL
Practice Address - Zip Code:60440-5114
Practice Address - Country:US
Practice Address - Phone:630-312-7755
Practice Address - Fax:630-856-9933
Is Sole Proprietor?:No
Enumeration Date:2006-05-12
Last Update Date:2017-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036100557208M00000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILP00471355OtherMEDICARE RAILROAD
ILK47103Medicare PIN
H18087Medicare UPIN
ILK47105Medicare PIN
IL036100557Medicaid