Provider Demographics
NPI:1184355174
Name:AL ALI, FAISAL OSAMA AHMED (MD)
Entity type:Individual
Prefix:MR
First Name:FAISAL
Middle Name:OSAMA AHMED
Last Name:AL 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 1:4309 W. MEDICAL CENTER DRIVE
Mailing Address - Street 2:SUITE A104
Mailing Address - City:MCHENRY
Mailing Address - State:IL
Mailing Address - Zip Code:60050
Mailing Address - Country:US
Mailing Address - Phone:857-239-0077
Mailing Address - Fax:
Practice Address - Street 1:4309 W. MEDICAL CENTER DRIVE
Practice Address - Street 2:SUITE A104
Practice Address - City:MCHENRY
Practice Address - State:IL
Practice Address - Zip Code:60050
Practice Address - Country:US
Practice Address - Phone:857-239-0077
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-06-21
Last Update Date:2022-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
IL125079959207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program