Provider Demographics
NPI:1184804668
Name:MRS GHOUSIA B ALI MD & MOHAMMED MASOOD ALI MD
Entity type:Organization
Organization Name:MRS GHOUSIA B ALI MD & MOHAMMED MASOOD ALI MD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:GHOUSIA
Authorized Official - Middle Name:BEGIM
Authorized Official - Last Name:ALI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:773-274-3060
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 1:2040 W DEVON AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60659-2128
Practice Address - Country:US
Practice Address - Phone:773-274-3060
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-13
Last Update Date:2010-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036084980207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036084980Medicaid
IL036084980Medicaid