Provider Demographics
NPI:1952520504
Name:MIR AKIF ALI MD PC
Entity Type:Organization
Organization Name:MIR AKIF ALI MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MIR
Authorized Official - Middle Name:AKIF
Authorized Official - Last Name:ALI
Authorized Official - Suffix:
Authorized Official - Credentials:MD PC
Authorized Official - Phone:630-276-8282
Mailing Address - Street 1:2400 W DEVON AVE
Mailing Address - Street 2:STE# 213
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60659-1910
Mailing Address - Country:US
Mailing Address - Phone:630-941-5295
Mailing Address - Fax:773-279-6515
Practice Address - Street 1:2400 W DEVON AVE
Practice Address - Street 2:STE# 213
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60659-1910
Practice Address - Country:US
Practice Address - Phone:630-941-5295
Practice Address - Fax:773-279-6515
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-24
Last Update Date:2015-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036047763208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036047763Medicaid
IL01622104OtherBCBS
IL01622104OtherBCBS
IL503120Medicare ID - Type Unspecified
IL036047763Medicaid