Provider Demographics
NPI:1235162025
Name:ALI, IMRAN WAJID (MD)
Entity Type:Individual
Prefix:DR
First Name:IMRAN
Middle Name:WAJID
Last Name:ALI
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 1:7447 W TALCOTT AVE STE 222
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60631-3713
Mailing Address - Country:US
Mailing Address - Phone:773-774-5245
Mailing Address - Fax:
Practice Address - Street 1:7447 W TALCOTT AVE STE 222
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60631-3713
Practice Address - Country:US
Practice Address - Phone:773-774-5245
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-08
Last Update Date:2020-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036114351207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036114351Medicaid
IL21622931OtherBCBS GROUP NUMBER
IL036114351Medicaid
IL21622931OtherBCBS GROUP NUMBER
IL036114351Medicaid