Provider Demographics
NPI:1700152048
Name:ALI MEDICAL LLC
Entity Type:Organization
Organization Name:ALI MEDICAL LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:QAISER
Authorized Official - Middle Name:
Authorized Official - Last Name:JAWAID
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:630-952-1412
Mailing Address - Street 1:300 MEDICAL PLZ STE 100
Mailing Address - Street 2:
Mailing Address - City:LAKE ST LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63367-1484
Mailing Address - Country:US
Mailing Address - Phone:630-952-1412
Mailing Address - Fax:
Practice Address - Street 1:300 MEDICAL PLZ STE 100
Practice Address - Street 2:
Practice Address - City:LAKE ST LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63367-1484
Practice Address - Country:US
Practice Address - Phone:630-952-1412
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-03-30
Last Update Date:2021-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Multi-Specialty
No207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatologyGroup - Multi-Specialty