Provider Demographics
NPI:1932217643
Name:ANSARI-ALI, SHAIBA ZEENATH (MD)
Entity Type:Individual
Prefix:DR
First Name:SHAIBA
Middle Name:ZEENATH
Last Name:ANSARI-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 1:302 RANDALL RD STE 105
Mailing Address - Street 2:
Mailing Address - City:GENEVA
Mailing Address - State:IL
Mailing Address - Zip Code:60134-4219
Mailing Address - Country:US
Mailing Address - Phone:630-232-2391
Mailing Address - Fax:630-232-2472
Practice Address - Street 1:302 RANDALL RD STE 105
Practice Address - Street 2:
Practice Address - City:GENEVA
Practice Address - State:IL
Practice Address - Zip Code:60134-4219
Practice Address - Country:US
Practice Address - Phone:630-232-2391
Practice Address - Fax:630-232-2472
Is Sole Proprietor?:No
Enumeration Date:2006-08-25
Last Update Date:2019-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036110832207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036110832Medicaid
206147OtherMEDICARE PTAN (GROUP)
206147042OtherMEDICARE PTAN (INDIVIDUAL)