Provider Demographics
NPI:1922034909
Name:ALI, MIR AKIF (MD)
Entity Type:Individual
Prefix:MR
First Name:MIR
Middle Name:AKIF
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 1:3303 W. 26TH ST.
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60623-4036
Mailing Address - Country:US
Mailing Address - Phone:773-277-6589
Mailing Address - Fax:773-277-1841
Practice Address - Street 1:2400 W DEVON AVE
Practice Address - Street 2:STE# 213
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60659-1963
Practice Address - Country:US
Practice Address - Phone:773-277-6589
Practice Address - Fax:773-277-1841
Is Sole Proprietor?:No
Enumeration Date:2006-06-23
Last Update Date:2015-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036047763208D00000X
IL036-047763208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036047763Medicaid
IL01622104OtherBLUE CROSS BLUE SHIELD
IL036047763Medicaid
ILD12660Medicare UPIN
IL503120Medicare ID - Type Unspecified
IL503230Medicare ID - Type Unspecified