Provider Demographics
NPI:1821132911
Name:ALI, SAMINA (MD)
Entity Type:Individual
Prefix:DR
First Name:SAMINA
Middle Name:
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:PO BOX 5005
Mailing Address - Street 2:
Mailing Address - City:GLENDALE HEIGHTS
Mailing Address - State:IL
Mailing Address - Zip Code:60139-5005
Mailing Address - Country:US
Mailing Address - Phone:630-784-8600
Mailing Address - Fax:630-456-4086
Practice Address - Street 1:1118 BLOOMINGDALE RD
Practice Address - Street 2:
Practice Address - City:GLENDALE HEIGHTS
Practice Address - State:IL
Practice Address - Zip Code:60139-3498
Practice Address - Country:US
Practice Address - Phone:630-784-8600
Practice Address - Fax:630-456-4086
Is Sole Proprietor?:No
Enumeration Date:2007-02-20
Last Update Date:2012-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036-093123208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036093123Medicaid