Provider Demographics
NPI:1255718037
Name:ALI, TARA AFSAR (MD)
Entity type:Individual
Prefix:
First Name:TARA
Middle Name:AFSAR
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 1:5300 LEE ST
Mailing Address - Street 2:
Mailing Address - City:SKOKIE
Mailing Address - State:IL
Mailing Address - Zip Code:60077-5102
Mailing Address - Country:US
Mailing Address - Phone:773-653-3322
Mailing Address - Fax:
Practice Address - Street 1:5300 LEE ST
Practice Address - Street 2:
Practice Address - City:SKOKIE
Practice Address - State:IL
Practice Address - Zip Code:60077-5102
Practice Address - Country:US
Practice Address - Phone:773-653-3322
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-04-30
Last Update Date:2015-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program