Healthcare Provider Details

I. General information

NPI: 1205572096
Provider Name (Legal Business Name): ALI BAIRD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/05/2022
Last Update Date: 06/17/2024
Certification Date: 06/14/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1611 W HARRISON ST STE 550
CHICAGO IL
60612-4861
US

IV. Provider business mailing address

1611 W HARRISON ST STE 550
CHICAGO IL
60612-4861
US

V. Phone/Fax

Practice location:
  • Phone: 312-942-6100
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License Number125.083305
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: