Provider Demographics
NPI:1376564815
Name:ALI, MADAD (MD)
Entity type:Individual
Prefix:DR
First Name:MADAD
Middle Name:
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 1:1 INGALLS DR
Mailing Address - Street 2:
Mailing Address - City:HARVEY
Mailing Address - State:IL
Mailing Address - Zip Code:60426-3558
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1 INGALLS DR
Practice Address - Street 2:
Practice Address - City:HARVEY
Practice Address - State:IL
Practice Address - Zip Code:60426-3558
Practice Address - Country:US
Practice Address - Phone:855-826-3878
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-21
Last Update Date:2024-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXU2767207RG0100X, 207R00000X
MO2002027101207RG0100X
NY121321207RG0100X
TX47868207RG0100X, 207R00000X
NJ25MA03726400207RG0100X
TX99999207RG0100X, 207R00000X
PAMD451324207RG0100X
IL036140847207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO174360OtherALLIANCE BLUE CROSS BLUE SHIELD
MO206012700Medicaid
PA103215762Medicaid
MO174360OtherALLIANCE BLUE CROSS BLUE SHIELD
MO206012700Medicaid