Provider Demographics
NPI:1518969518
Name:ALI, GHOUSIA BEGUM (MD)
Entity Type:Individual
Prefix:
First Name:GHOUSIA
Middle Name:BEGUM
Last Name:ALI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5800 KEENEY ST
Mailing Address - Street 2:
Mailing Address - City:MORTON GROVE
Mailing Address - State:IL
Mailing Address - Zip Code:60053-3551
Mailing Address - Country:US
Mailing Address - Phone:847-674-6611
Mailing Address - Fax:
Practice Address - Street 1:2136 W DEVON AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60659-2127
Practice Address - Country:US
Practice Address - Phone:773-274-3060
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-08-10
Last Update Date:2010-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036084980207QA0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QA0000XAllopathic & Osteopathic PhysiciansFamily MedicineAdolescent Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036084980Medicaid
IL036084980Medicaid
ILL66506Medicare UPIN