Provider Demographics
NPI:1255317194
Name:ALI, MIR H (MD)
Entity Type:Individual
Prefix:
First Name:MIR
Middle Name:H
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 1:725 SCHOOL ST STE A
Mailing Address - Street 2:
Mailing Address - City:MORRIS
Mailing Address - State:IL
Mailing Address - Zip Code:60450-1207
Mailing Address - Country:US
Mailing Address - Phone:815-941-9124
Mailing Address - Fax:815-941-4363
Practice Address - Street 1:1051 W US ROUTE 6
Practice Address - Street 2:SUITE 100
Practice Address - City:MORRIS
Practice Address - State:IL
Practice Address - Zip Code:60450-4200
Practice Address - Country:US
Practice Address - Phone:815-942-4875
Practice Address - Fax:815-942-5046
Is Sole Proprietor?:No
Enumeration Date:2005-12-22
Last Update Date:2021-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036.122446207X00000X
IL036-122446207XS0117X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XS0117XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryOrthopaedic Surgery of the Spine
No207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036.122446OtherLICENSE
IL204321003Medicare PIN