Healthcare Provider Details

I. General information

NPI: 1760944763
Provider Name (Legal Business Name): MANSOOR ALI MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: MANSOOR SYED ALI MD

II. Dates (important events)

Enumeration Date: 04/01/2019
Last Update Date: 08/10/2026
Certification Date: 08/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1045 W STEPHENSON ST
FREEPORT IL
61032-4864
US

IV. Provider business mailing address

8627 SCHOOL ST
MORTON GROVE IL
60053-2922
US

V. Phone/Fax

Practice location:
  • Phone: 815-599-6000
  • Fax: 815-599-7974
Mailing address:
  • Phone: 224-766-9130
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number036158592
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number036158592
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: