MEDICARE: MIR AKIF ALI MD PC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208D00000X	General Practice Physician	036047763	IL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	01622104	OTHER	IL	BCBS

General Provider Information

NPI Number	:	1952520504
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MIR AKIF ALI MD PC

Provider Business Mailing Address
First Line	:	2400 W DEVON AVE
Second Line	:	STE# 213
City	:	CHICAGO
State	:	IL
Zip	:	60659-1910
Country	:	US
Telephone Number	:	630-941-5295
Fax Number	:	773-279-6515

Provider Business Practice Location Address
First Line	:	2400 W DEVON AVE
Second Line	:	STE# 213
City	:	CHICAGO
State	:	IL
Zip	:	60659-1910
Country	:	US
Telephone Number	:	630-941-5295
Fax Number	:	773-279-6515

Authorized Official
Title or Position	:	OWNER
Name	:	DR. MIR AKIF ALI
Credential	:	MD PC
Telephone Number	:	630-276-8282

Provider Enumeration Date	:	04/24/2007
Last Update Date	:	12/17/2015

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