Provider Demographics
NPI:1669943445
Name:BAIG, MOHAMMED ALI
Entity type:Individual
Prefix:
First Name:MOHAMMED
Middle Name:ALI
Last Name:BAIG
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7310 TIFFANY DR APT 2B
Mailing Address - Street 2:
Mailing Address - City:ORLAND PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60462-3589
Mailing Address - Country:US
Mailing Address - Phone:708-262-2547
Mailing Address - Fax:
Practice Address - Street 1:4800 148TH ST
Practice Address - Street 2:
Practice Address - City:MIDLOTHIAN
Practice Address - State:IL
Practice Address - Zip Code:60445-3117
Practice Address - Country:US
Practice Address - Phone:708-687-1604
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-12-05
Last Update Date:2018-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL051301799183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist