Provider Demographics
NPI:1285639179
Name:SALIMI, ALI (MD)
Entity Type:Individual
Prefix:
First Name:ALI
Middle Name:
Last Name:SALIMI
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 1:3331 W DEYOUNG ST STE 308
Mailing Address - Street 2:
Mailing Address - City:MARION
Mailing Address - State:IL
Mailing Address - Zip Code:62959-5898
Mailing Address - Country:US
Mailing Address - Phone:618-998-0052
Mailing Address - Fax:618-997-9103
Practice Address - Street 1:3331 W DEYOUNG ST
Practice Address - Street 2:STE 308
Practice Address - City:MARION
Practice Address - State:IL
Practice Address - Zip Code:62959-5898
Practice Address - Country:US
Practice Address - Phone:618-998-0052
Practice Address - Fax:618-997-9103
Is Sole Proprietor?:No
Enumeration Date:2005-06-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL36055998207R00000X
MO34889207RC0000X, 207RI0011X
NY194072-1207RC0000X, 207RI0011X
IL207RC0000X, 207RI0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Not Answered207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Not Answered207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL0360559982Medicaid
ILK04398Medicare ID - Type Unspecified
IL0360559982Medicaid