Healthcare Provider Details

I. General information

NPI: 1184804668
Provider Name (Legal Business Name): MRS GHOUSIA B ALI MD & MOHAMMED MASOOD ALI MD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/13/2007
Last Update Date: 08/13/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2040 W DEVON AVE
CHICAGO IL
60659-2128
US

IV. Provider business mailing address

5800 KEENEY ST
MORTON GROVE IL
60053-3551
US

V. Phone/Fax

Practice location:
  • Phone: 773-274-3060
  • Fax:
Mailing address:
  • Phone: 847-674-6611
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number036084980
License Number StateIL

VIII. Authorized Official

Name: DR. GHOUSIA BEGIM ALI
Title or Position: PHYSICIAN
Credential: MD
Phone: 773-274-3060