Healthcare Provider Details

I. General information

NPI: 1003754300
Provider Name (Legal Business Name): KHLIQ ALI
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/25/2026
Last Update Date: 03/25/2026
Certification Date: 03/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3042 W ROOSEVELT RD
CHICAGO IL
60612-3981
US

IV. Provider business mailing address

101 RICHARDS ST APT 1
JOLIET IL
60433-1016
US

V. Phone/Fax

Practice location:
  • Phone: 312-826-5143
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3747P1801X
TaxonomyPersonal Care Attendant
License Number
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: